Old Mission Medicine Wound Care New York PLLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

OLD MISSION MEDICINE WOUND CARE NEW YORK PLLC

Practice address

1989 Kroupa Rd
Traverse City, MI 49686-9759

Phone

(231) 260-4622

NPI assigned

May 20, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Christopher Paul Mason, DO

Title

Owner

Phone

(231) 260-4622

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kim Bova, NP

  • Family Nurse Practitioner
  • Syracuse, NY
  • NPI 1861119125
  Medicare reassignment NPD
• Matthew Fisher

  • Physician Assistant
  • Burnt Hills, NY
  • NPI 1245901297
  Medicare reassignment NPD
• Lisa M Grolling, RN

  • Family Nurse Practitioner
  • Hilton, NY
  • NPI 1427665082
  Medicare reassignment NPD
• Seana Mosher, PA

  • Physician Assistant
  • Saratoga Springs, NY
  • NPI 1881758597
  Medicare reassignment NPD
• Christopher John Norman, MSN, APRN, AGPCNP-BC

  • Adult Health Nurse Practitioner
  • Syracuse, NY
  • NPI 1326442476
  Medicare reassignment NPD
• Tiffany Lee Rowe, NP

  • Adult Health Nurse Practitioner
  • Rochester, NY
  • NPI 1265613442
  Medicare reassignment NPD
• Timothy Mihm, P.A.

  • Medical Physician Assistant
  • Oneida, NY
  • NPI 1659301729
  Medicare reassignment
• Jessie Blair Rink, N.P.

  • Family Nurse Practitioner
  • Jamestown, NY
  • NPI 1043574163
  NPD

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

{
    "created_epoch": "1716163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724457600000",
    "number": "1043059298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 MATLAGE WAY UNIT 31",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774870807",
            "telephone_number": "231-260-4622"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1989 KROUPA RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496869759",
            "telephone_number": "231-260-4622"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OLD MISSION MEDICINE WOUND CARE NEW YORK PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-20",
        "last_updated": "2024-08-24",
        "certification_date": "2024-08-24",
        "status": "A",
        "authorized_official_last_name": "MASON",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_middle_name": "PAUL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-260-4622",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brendan Odonnel, LMSW
• Kean T Oh, M.D.
• Kevin James Ohara, LBSW
• Stephen Henry Oklat, PHYSICIAN ASSISTANT
• Old Mission Advanced Care, PLLC
• Old Mission Peninsula Dentistry RC
• Old Mission Wound Care Arizona PLLC
• Old Mission Wound Care Colorado PLLC
• Old Mission Wound Care Florida PLLC
• Old Mission Wound Care Georgia LLC

• Specialist in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.