Individual provider Active NPI

Ward Robert Gillett, M.D.

  • Urology Physician
  • Traverse City, MI
National Provider Identifier
1053302562
Registry record updated Dec 18, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
4301045761 Issued in MI
Practice address
3922 Cedar Run Rd
Traverse City, MI 49684-9687
Phone
(231) 935-0322
Fax
(231) 935-0334
NPI assigned
Nov 3, 2005
Last updated
Dec 18, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 18, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 4301045761 MI Primary

Addresses

Primary practice location

3922 Cedar Run Rd
Traverse City, MI 49684-9687

Mailing address

3922 Cedar Run Rd
Traverse City, MI 49684-9687
Phone (231) 935-0322

Other identifiers 1

IdentifierTypeStateIssuer
3480016MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address wgillett@direct.mhc.net

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100326000522 MI Practitioner - Urology 1052301322 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Center Current Accepting new patients
Munson Medical Center Urology CurrentSince Dec 1, 2014 Accepting new patients
Munson Medical Center CurrentSince Dec 1, 2014 Accepting new patients

Locations

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

224 Park Ave
Frankfort, MI 49635
Phone (231) 352-2200

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

1221 Sixth St
Ste 100
Traverse City, MI 49684
Phone (231) 392-8400

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

3922 Cedar Run Rd
Traverse City, MI 49684
Phone (231) 392-0430

Interoperability endpoints

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

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608249600000",
    "number": "1053302562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3922 CEDAR RUN RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849687",
            "telephone_number": "231-935-0322",
            "fax_number": "231-935-0334"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3922 CEDAR RUN RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849687",
            "telephone_number": "231-935-0322",
            "fax_number": "231-935-0334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLETT",
        "first_name": "WARD",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-03",
        "last_updated": "2020-12-18",
        "certification_date": "2020-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "MI",
            "license": "4301045761",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3480016",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wgillett@direct.mhc.net",
            "affiliation": "N",
            "address_1": "3922 Cedar Run Rd",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496849687",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.