NPIMap

Individual provider Active NPI

Elizabeth Shannon Elliot, D.O.

  • Internal Medicine Physician
  • Traverse City, MI
National Provider Identifier
1013919109
Registry record updated Sep 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
5101012067 Issued in MI
Practice address
5041 N Royal Dr
Traverse City, MI 49684-6986
Phone
(231) 935-0600
Fax
(231) 935-0613
NPI assigned
Jun 2, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 12, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Hospitalist Physician 208M00000X 5101012067 MI
Internal Medicine Physician 207R00000X 5101012067 MI Primary

Addresses

Primary practice location

5041 N Royal Dr
Traverse City, MI 49684-6986

Mailing address

1105 Sixth St
Traverse City, MI 49684-2345
Phone (231) 935-0600

Other identifiers 4

IdentifierTypeStateIssuer
1013919109OtherMINPI #
70-0-F32947-0OtherMIBCBS CPIN #
70-0-F32947-0OtherMIBCBS CPIN
4846781MedicaidMI

Other names 1

  • Elizabeth Shannon Wireman Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address elizabeth.elliot@mmp.eclinicaldirectplus.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20251117000108 CO Practitioner - Internal Medicine 5496718389 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Michigan State University College of Osteopathic Medicine, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boulder Community HealthGroup PAC ID 6800707233, 260 clinicians

Practice addresses (Care Compare)

101 Erie Pkwy
Suite 201C
Erie, CO 80516-4072
Phone (303) 415-5816

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Community Health CurrentSince Dec 15, 2025 Accepting new patients
Munson Medical Group Current Accepting new patients
Boulder Community Health CurrentSince Dec 15, 2025 Accepting new patients
Munson Medical Group Internal Medicine Current Accepting new patients
Munson Medical Center Current Accepting new patients
Senior Health Care Associates, PC Past Accepting new patients
Boulder Community Health Past Accepting new patients

Locations

1755 48th St
Ste 200
Boulder, CO 80301
Phone (303) 415-7450

101 Erie Pkwy
Ste 201C
Erie, CO 80516
Phone (303) 415-5816

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

2891 Momentum Pl
Chicago, IL 60689

5041 N Royal Dr
Traverse City, MI 49684
Phone (231) 392-8400

1400 Medical Campus Dr
Traverse City, MI 49684
Phone (231) 935-8000

224 Circle Dr
Traverse City, MI 49684
Phone (231) 932-4912

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

1200 Sixth St
Ste 200
Traverse City, MI 49684

Networks

  • devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a
  • CO HMO
  • CO HMO D-SNP

Interoperability endpoints

  • Direct secure messaging: eelliot@direct.mhc.net

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 34

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 34

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726099200000",
    "number": "1013919109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842345",
            "telephone_number": "231-935-0600",
            "fax_number": "231-935-0613"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5041 N ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496846986",
            "telephone_number": "231-935-0600",
            "fax_number": "231-935-0613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOT",
        "first_name": "ELIZABETH",
        "middle_name": "SHANNON",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-06-02",
        "last_updated": "2024-09-12",
        "certification_date": "2024-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "MI",
            "license": "5101012067",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "5101012067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI #",
            "identifier": "1013919109",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS CPIN #",
            "identifier": "70-0-F32947-0",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS CPIN",
            "identifier": "70-0-F32947-0",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4846781",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "elizabeth.elliot@mmp.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "224 Circle Dr",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496842700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "WIREMAN",
            "middle_name": "SHANNON",
            "credential": "D.O.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.