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MR. JACOB XAVIER MCCLELLAN DO
NPI 1205637469
Student in an Organized Health Care Education/Training Program in Warren, MI

Active since March 24, 2025PECOS Enrolled
11900 E 12 MILE RD STE 205, WARREN, MI 48093(586) 582-7033(586) 200-6944 Get Directions Write a Review

NPPES record last updated: March 24, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Jacob Xavier Mcclellan Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. JACOB XAVIER MCCLELLAN DO (NPI 1205637469) is an individual student in an organized health care education/training program in Warren, Michigan and active in the NPI registry since March 2025. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1205637469
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameMR. JACOB XAVIER MCCLELLANCredential: DO
Location Address11900 E 12 MILE RD STE 205Warren, MI 48093-3499
Mailing Address11800 E 12 Mile RdWarren, MI 48093-3472
Phone(586) 582-7033
Fax(586) 200-6944
Sole ProprietorYes
Enumeration DateMarch 24, 2025
NPPES CertifiedMarch 23, 2025
✔ NPI 1205637469 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care
Taxonomy Code390200000X
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
11900 E 12 MILE RD STE 205, Warren, MI 48093
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mr. Jacob Xavier Mcclellan Do is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 9

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

ANASTASIYA YASHCHUK DO
Student in an Organized Health Care Education/Training Program
11900 E 12 MILE RD STE 205
WARREN, MI 48093
Macomb County (586) 582-7033
AYUSH GUPTA MD
Student in an Organized Health Care Education/Training Program
11900 E 12 MILE RD STE 205
WARREN, MI 48093
Macomb County (586) 582-7033
MICHAEL WILCOX DO
Psychiatry & Neurology (Neurology)
11900 E 12 MILE RD STE 205
WARREN, MI 48093
Macomb County (586) 582-7033
MICHAEL JOSEPH MCCARTHY MD
Student in an Organized Health Care Education/Training Program
11900 E 12 MILE RD STE 205
WARREN, MI 48093
Macomb County (586) 582-7033
SHAD M HINES DO
Student in an Organized Health Care Education/Training Program
11900 E 12 MILE RD STE 205
WARREN, MI 48093
Macomb County (586) 582-7034
MANHA AZAM
Student in an Organized Health Care Education/Training Program
11900 E 12 MILE RD STE 205
WARREN, MI 48093
Macomb County (586) 582-7033
CHRISTOPHER HANANI DO
Student in an Organized Health Care Education/Training Program
11900 E 12 MILE RD STE 205
WARREN, MI 48093
Macomb County (586) 582-7033
SILVIA TIFFANY MENKES DO
Student in an Organized Health Care Education/Training Program
11900 E 12 MILE RD STE 205
WARREN, MI 48093
Macomb County (586) 582-7033

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jacob Mcclellan's NPI number?

The NPI number for Jacob Mcclellan is 1205637469. It was assigned to this individual provider in the NPPES registry on March 24, 2025.

Where is Jacob Mcclellan located?

Jacob Mcclellan practices at 11900 E 12 Mile Rd Ste 205, Warren, MI 48093. The listed phone number is (586) 582-7033.

What is Jacob Mcclellan's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Jacob Mcclellan enrolled in Medicare?

Yes. Jacob Mcclellan is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jacob Mcclellan was last updated on March 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.