NPIMap

Individual provider Active NPI

Christopher Brian Gong, MD

  • Surgery Physician
  • Bad Axe, MI
National Provider Identifier
1053497149
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
43010617599 Issued in 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
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 036-105202 IL
Surgery Physician 208600000X 43010617599 MI Primary
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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20040825000043 MI Practitioner - General Surgery 7012981087 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
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 PLLCGroup PAC ID 0143737148, 128 clinicians

Practice addresses (Care Compare)

4782 Hospital Dr
Cass City, MI 48726-1049
Phone (989) 872-2174

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-105202ILMDSurgery Physician
43010617599MIMDSurgery Physician
39798-020WIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Complexcare Medical Group Midwest H PLLC CurrentSince Jun 10, 2025 Accepting new patients
Theoria Medical CurrentSince Jan 13, 2024 Accepting new patients
Cass City Opco LLC Past Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital PastSince Jan 1, 1990 Accepting new patients
Tawas City Opco LLC Past Accepting new patients
Wellbridge of Clarkston, LLC Past Accepting new patients
Four Seasons Nursing Center LLC Past Accepting new patients
Lakeview Manor Acquisition Company, Inc. 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

  • Direct secure messaging: cgong49809@direct.covenanthealthcare.com

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Lakeview ManorTawas City, MI, CCN 235515 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jan 1, 2025
Jan 1, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1162252800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1053497149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1040 S VAN DYKE RD",
            "address_2": "SUITE 1",
            "city": "BAD AXE",
            "state": "MI",
            "postal_code": "484139646",
            "telephone_number": "989-269-6911",
            "fax_number": "989-269-9162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 S VAN DYKE RD",
            "address_2": "SUITE 1",
            "city": "BAD AXE",
            "state": "MI",
            "postal_code": "484139646",
            "telephone_number": "989-269-6911",
            "fax_number": "989-269-9162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GONG",
        "first_name": "CHRISTOPHER",
        "middle_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-31",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036-105202",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "43010617599",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "39798-020",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bad Axe, MI

Sources for this page

Verify at the official NPI Registry.