JACOB RYAN GACKE
NPI 1891378477
Student in an Organized Health Care Education/Training Program in Detroit, MI

Q: What is Jacob Gacke's NPI number?

The NPI number for Jacob Gacke is 1891378477. It was assigned to this individual provider in the NPPES registry on May 3, 2021.

Q: What is Jacob Gacke'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 Jacob Gacke was last updated on May 3, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years 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 May 03, 2021PECOS Enrolled

2799 W GRAND BLVD, DETROIT, MI 48202(313) 916-1601(313) 916-2018 Get Directions Write a Review

NPPES record last updated: May 3, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Jacob Ryan Gacke NPPES

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

JACOB RYAN GACKE (NPI 1891378477) is an individual student in an organized health care education/training program in Detroit, Michigan and active in the NPI registry since May 2021. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1891378477

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameJACOB RYAN GACKE

Location Address2799 W GRAND BLVDDetroit, MI 48202-2689

Mailing Address15510 Emerald DrLa Pine, OR 97739-9549 · (541) 280-1515

Phone(313) 916-1601

Fax(313) 916-2018

Sole ProprietorNo

Enumeration DateMay 3, 2021

NPPES CertifiedMay 3, 2021

✔ NPI 1891378477 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.

2799 W GRAND BLVD, Detroit, MI 48202

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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)

Jacob Ryan Gacke 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.

HENRY FORD HOSPITAL

General Acute Care Hospital