MR. JACK PHILIP PALMER DO
NPI 1619626017
Student in an Organized Health Care Education/Training Program in Detroit, MI

Q: What is Jack Palmer's NPI number?

The NPI number for Jack Palmer is 1619626017. It was assigned to this individual provider in the NPPES registry on March 22, 2022.

Q: What is Jack Palmer's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Jack Palmer was last updated on May 16, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.

Active since March 22, 2022PECOS Enrolled

22201 MOROSS RD STE 50, DETROIT, MI 48236(313) 343-7774(313) 343-8747 Get Directions Write a Review

NPPES record last updated: May 16, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Mr. Jack Philip Palmer Do NPPES

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

MR. JACK PHILIP PALMER DO (NPI 1619626017) is an individual student in an organized health care education/training program in Detroit, Michigan and active in the NPI registry since March 2022. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1619626017

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameMR. JACK PHILIP PALMERCredential: DO

Location Address22201 MOROSS RD STE 50Detroit, MI 48236-2166

Mailing Address22201 Moross Rd Ste 50Detroit, MI 48236-2891 · (313) 343-4612 · Fax (313) 417-0452

Phone(313) 343-7774

Fax(313) 343-8747

Sole ProprietorNo

Enumeration DateMarch 22, 2022

Last NPPES UpdateMay 16, 2025

NPPES CertifiedMay 16, 2025

✔ NPI 1619626017 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.

22201 MOROSS RD STE 50, Detroit, MI 48236

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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. Jack Philip Palmer 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 20

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

AMR EL-MOUSA

Student in an Organized Health Care Education/Training Program