DR. JERRY SAMUEL WALDEN (NPI# 1427168913) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427168913 |
| Entity Type | Individual |
| Full Name | DR. JERRY SAMUEL WALDEN |
| Credential | M.D. |
| Practice Address |
3174 Packard St Ann Arbor MI 48108-1947 |
| Practice Telephone | 7349711073 |
| Practice Fax Number | 7349718545 |
| Mailing Telephone | 7349711073 |
| Mailing Fax Number | 7349718545 |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-09 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | JW027573 | MI | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MI | HAP | B45555 | 01 |
| MI | BLUE CARE NETWORK | 0817265 | 01 |
| MI | M-CARE | C-2855 | 01 |
| MI | BCBS | 0808172651 | 01 |
| MI | CARE CHOICES | 103791 | 01 |
| MI | 1639933 | 05 |
| Street Address |
3174 PACKARD ST |
| City | ANN ARBOR |
| State | MI |
| Zip Code | 48108-1947 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124085972 | Carisalyn Nicole Cousin | Nurse Practitioner | 3174 Packard St, Ann Arbor, MI 48108-1947 | 2006-04-26 |
| 1467069492 | Corey Telin | Social Worker | 3174 Packard St, Ann Arbor, MI 48108-1947 | 2020-09-24 |
| 1487175048 | Grace Kelley | Registered Nurse | 3174 Packard St, Ann Arbor, MI 48108 | 2017-07-03 |
| 1174050694 | Elizabeth Annette Patterson | Nurse Practitioner | 3174 Packard St, Ann Arbor, MI 48108-1947 | 2017-05-15 |
| 1922491760 | Packard Health, Inc. | Clinic/Center | 3174 Packard St, Ann Arbor, MI 48108-1947 | 2015-03-17 |
| 1609216795 | Angie L. Wang | Family Medicine | 3174 Packard St, Ann Arbor, MI 48108-1947 | 2013-07-03 |
| 1700137528 | Kari M Bail | Nurse Practitioner | 3174 Packard St, Ann Arbor, MI 48108-1947 | 2012-09-20 |
| 1982970380 | Ronald Romero | Family Medicine | 3174 Packard St, Ann Arbor, MI 48108-1947 | 2012-03-29 |
| 1225304272 | Victoria Jean Nichols | Family Medicine | 3174 Packard St, Ann Arbor, MI 48108-1947 | 2012-03-23 |
| 1710250477 | Meaghan Cotter | Registered Nurse | 3174 Packard St, Ann Arbor, MI 48108-1947 | 2012-02-10 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750999249 | Creating Brighter Futures | Behavioral Analyst | 4201 Varsity Drive, Ste. C, Ann Arbor, MI 48108 | 2020-07-21 |
| 1326506320 | Michelle Bishop | Behavior Technician | 4935 Birch Hollow Dr, Ann Arbor, MI 48108 | 2019-03-08 |
| 1407326077 | Alexis Ewald | Behavior Technician | 2770 Carpenter Rd., Ann Arbor, MI 48108 | 2018-11-27 |
| 1003308511 | Ann Arbor Dental Specialists | Dentist | 3100 Eisenhower Parkway, Suite 200, Ann Arbor, MI 48108 | 2018-05-31 |
| 1144719295 | Jonathan Parker Etter | Physical Medicine & Rehabilitation | 325 E. Eisenhower, Suite 300, Spc 5744, Ann Arbor, MI 48108 | 2018-05-04 |
| 1427555895 | Blossom Health Services LLC | Social Worker | 2156 Glencoe Hills Dr Apt 12, Ann Arbor, MI 48108 | 2018-04-11 |
| 1669974580 | Camron Anthony Moorehead | Occupational Therapist | 400 E. Eisenhower Parkway Bldg 2, Ste A, Ann Arbor, MI 48108 | 2018-03-07 |
| 1396247862 | Crystal Ann D'agostino | Health Educator | 1169 Oak Valley Drive, Ann Arbor, MI 48108 | 2018-03-01 |
| 1538671250 | Miea Moon | Psychologist | 3200 E Eisenhower Parkway, Moriah Hall, Ann Arbor, MI 48108 | 2017-11-03 |
| 1003355546 | Rachael Connolly | Behavior Technician | 4201 Varsity Drive Suite C, Ann Arbor, MI 48108 | 2017-02-16 |
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| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164950481 | Ryan Kenneth Smith | Family Medicine | 4350 Jackson Rd Ste 230, Ann Arbor, MI 48103-1890 | 2017-05-31 |
| 1730620386 | Rachel Denny | Family Medicine | 4260 Plymouth Rd # B1-313, Ann Arbor, MI 48109-2700 | 2017-03-15 |
| 1730546722 | Scott Waclawik | Family Medicine | 24 Frank Lloyd Wright Dr Ste L2300, Ann Arbor, MI 48105-9484 | 2016-01-21 |
| 1477940294 | Advance Primary Care | Family Medicine | 1000 E Stadium Blvd Ste E, Ann Arbor, MI 48104-4616 | 2015-04-20 |
| 1598179822 | Kristina L Bahrou | Family Medicine | 3830 Packard St Ste 230, Ann Arbor, MI 48108-2273 | 2014-06-14 |
| 1164862249 | Gregory David Shumer | Family Medicine | 24 Frank Lloyd Wright Dr Lbby H, Ann Arbor, MI 48105-9484 | 2013-07-03 |
| 1629321096 | Rachel Leah Sabb | Family Medicine | 1000 Markbarry Dr, Ann Arbor, MI 48105-2869 | 2012-10-22 |
| 1336401124 | Sukhpreet Kaur Singh | Family Medicine | 2755 Carpenter Rd Ste 1s, Ann Arbor, MI 48108-1171 | 2012-06-08 |
| 1194002824 | Superior Physician Services Pllc | Family Medicine | 315 E Eisenhower Pkwy Ste 7, Ann Arbor, MI 48108-3329 | 2011-11-09 |
| 1629380530 | Lindsey V. Kotagal | Family Medicine | 501 N Maple Rd, Ann Arbor, MI 48103-2827 | 2010-07-08 |
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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.