Christopher Brian Gong, MD
Individual provider Active NPI Surgery Physician · Bad Axe, MI
NPI 1053497149 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1053497149
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Surgery Physician 208600000X
- License
- 43010617599 (MI)
- Practice address
- 1040 S Van Dyke Rd
Suite 1
Bad Axe, MI 48413-9646 - Phone
- (989) 269-6911
- Fax
- (989) 269-9162
- NPI assigned
- Oct 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Hospital & facility affiliations 10
Owned or controlled facilities with NPI records 1
Medicare Care Compare profile
- Specialty
- General Surgery
- Education
- Rush Medical College of Rush University, 1993
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Complexcare Medical Group Midwest H PLLC
Practice addresses (Care Compare)
4782 Hospital Dr
Cass City, MI 48726-1049
Phone (989) 872-2174
Hospital & facility affiliations
- The Care Team Hospice
- Heartland Hospice (West Branch)
- Tawas St Joseph Hospital
- Medilodge of Tawas City
- Lakeview Manor Healthcare Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Lakeview Manor |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Jan 1, 2025 Jan 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040825000043 | MI | Practitioner - General Surgery | 7012981087 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036-105202 | IL | MD | Surgery Physician |
| 43010617599 | MI | MD | Surgery Physician |
| 39798-020 | WI | MD | Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Complexcare Medical Group Midwest H PLLC | Current |
Accepting new patients | |
| Theoria Medical | Current |
Accepting new patients | |
| Tawas City Opco LLC | Past | Accepting new patients | |
| Lakeview Manor Acquisition Company, Inc. | Past | Accepting new patients | |
| DHHS, PHS, Naihs, Shiprock Hospital | Past |
Accepting new patients | |
| Four Seasons Nursing Center LLC | Past | Accepting new patients | |
| Cass City Opco LLC | Past | Accepting new patients |
Locations
1167 E Hopson St
Bad Axe, MI 48413
Phone (989) 269-9983
4782 Hospital Dr
Cass City, MI 48726
Phone (989) 872-2174
5655 Clarkston Rd
Clarkston, MI 48348
Phone (810) 623-5216
6700 W Outer Dr
Detroit, MI 48235
Phone (313) 836-1700
3139 E Baldwin Rd
Grand Blanc, MI 48439
Phone (810) 445-5300
41800 W 11 Mile Rd
Ste 109
Novi, MI 48375
Phone (833) 578-2763
Interoperability endpoints
- cgong49809@direct.covenanthealthcare.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 036-105202 | IL | |
| Surgery Physician | 208600000X | 43010617599 | MI | Yes |
| Surgery Physician | 208600000X | 39798-020 | WI |
Addresses
Primary practice location
1040 S Van Dyke Rd
Suite 1
Bad Axe, MI 48413-9646
Mailing address
1040 S Van Dyke Rd
Suite 1
Bad Axe, MI 48413-9646
Phone (989) 269-6911
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01601930371 | Other | MI | AMA |
Other providers in Bad Axe, MI
- Tennille Rochelle Gibson
- Kathleen Gilbert
- Michael Gilbert
- Laurie L Gillingham
- Erika Ileen Goebel
- Alexis Gonzales
- Bethany Gonzales
- Sofia Goodro
- Leigha Grannell
- Great Lakes Bay Health Centers
All providers in Bad Axe, MI · Surgery Physician in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.