Jaclyn Kamidoi

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

18073090341 Issued in MI

Practice address

1201 Stone St Ste 5
Port Huron, MI 48060-3563

Phone

(810) 966-9556

NPI assigned

Apr 7, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Riad R. Hajjar MD PC

  • Internal Medicine Physician
  • Port Huron, MI
  • NPI 1164620753
  Medicare reassignment NPD
• R S Balboa MDPC

  • Internal Medicine Physician
  • Port Huron, MI
  • NPI 1801024807
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1523059200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523059200000",
    "number": "1992202998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4200 OLD FORGE DR",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480594030",
            "telephone_number": "586-292-2012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 STONE ST STE 5",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480603563",
            "telephone_number": "810-966-9556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KAMIDOI",
        "first_name": "JACLYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-07",
        "last_updated": "2018-04-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MI",
            "license": "18073090341",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1538153176",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erin Yvette Kain
• Nicklaus Kaiser, LLMSW
• Simon Kaljaj, PHARMD
• Cole David Kamendat
• Marshall Kamer, M.D.
• Amy M Kandell, LMSW, LPC, LLP
• Leonard T Karadimas, DO
• Huseyin Sakib Karakilic
• Rubina Karim, MD
• Samprit Karra, DO

• Nurse Practitioner in Port Huron, MI
• Providers in Port Huron, MI by specialty
• Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.