CHARLES E JESSUP (NPI# 1992831960) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1992831960 |
| Entity Type | Individual |
| Full Name | CHARLES E JESSUP |
| Credential | DO |
| Practice Address |
125 N Washington St Prescott MI 48756-5117 |
| Mailing Address |
1003 Woodside Ave Essexville MI 48732-1234 |
| Practice Telephone | 9898733352 |
| Practice Fax Number | 9898733949 |
| Mailing Telephone | 9898927722 |
| Mailing Fax Number | 9898927455 |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2011-04-04 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207Q00000X | Family Medicine | 5101005335 | MI | Allopathic & Osteopathic Physicians |
| Y | 208D00000X | General Practice | 5101005335 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | RIVERBEND | 233873 | 01 |
| MI | BLUE CROSS | 080Z910290 | 01 |
| MI | RIVERBEND | 233866 | 01 |
| MI | BCBS | 0156150214 | 01 |
| MI | COMMERCIAL | 383369085 | 01 |
| MI | BCBS GROUP | 0Z90058 | 01 |
| MI | COMMUNITY CHOICE | 383369085100 | 01 |
| MI | 4303974 | 05 | |
| MI | COMMERCIAL | 382821013 | 01 |
| MI | BUE CROSS | 010F510190 | 01 |
| MI | BCBS GROUP | 010Z900580 | 01 |
| MI | 4279897 | 05 | |
| MI | 2624597 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558385898 | Charles A. Jessup | Optometrist | 4000 Little Blue Pkwy, Independence, MO 64057-8309 | 2006-07-27 |
| 1790216042 | Charles Kirk Jessup | Emergency Medicine | 1240 Huffman Mill Rd, Burlington, NC 27215-8700 | 2017-03-27 |
| Street Address |
125 N WASHINGTON ST |
| City | PRESCOTT |
| State | MI |
| Zip Code | 48756-5117 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568005569 | Jennifer Lynn Datzko | Nurse Practitioner | 125 N Washington St, Prescott, MI 48756-5117 | 2019-10-22 |
| 1295248508 | Prescott Clinic P.C. | Family Medicine | 125 N Washington St, Prescott, MI 48756-5117 | 2017-11-08 |
| 1578626735 | Richard Steven Gaft | Emergency Medicine | 125 N Washington St, Box 114, Prescott, MI 48756-5117 | 2006-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932571056 | Gabriel Wayne Wallace | Technician | 5208 Michiban Ave., Prescott, MI 48756 | 2015-10-28 |
| 1881622835 | Prescott Clinic P.C. | Family Medicine | 125 Washington, Prescott, MI 48756 | 2006-06-29 |
| 1407194954 | Jimmie S Ward Sr. | Physician Assistant | 125 Washington Ave, Prescott, MI 48756-5117 | 2013-01-17 |
| 1659379915 | Antonio F Mendiola Jr. | General Practice | 1827 Greenwood Rd, Prescott, MI 48756-8626 | 2005-07-12 |
| 1881679645 | Sterling Area Health Center | Clinic/Center | 1827 Greenwood Rd, Prescott, MI 48756-8626 | 2005-12-14 |
| 1851905707 | Skidway Pharmacy LLC | Pharmacy | 1830 Greenwood Rd, Prescott, MI 48756-8627 | 2020-09-08 |
| 1750319083 | Daniel Edward Greene | Chiropractor | 1818 Greenwood Rd, Prescott, MI 48756-8627 | 2006-06-28 |
| 1619477338 | Corinne Crawford | Behavior Technician | 3909 Rifle River Trl, Prescott, MI 48756-9345 | 2018-02-19 |
| 1598258329 | Aliyah Marie Allen | Behavior Technician | 5130 Greenwood Rd, Prescott, MI 48756-9616 | 2018-06-06 |
| 1558405217 | Roos Pharmacy North, Inc. | Pharmacy | 2370 Greenwood Rd, Prescott, MI 48756-9655 | 2007-02-16 |
| Find all providers in zip 48756 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
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| 1659379915 | Antonio F Mendiola Jr. | General Practice | 1827 Greenwood Rd, Prescott, MI 48756-8626 | 2005-07-12 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.