NPIMap

Individual provider Active NPI

Travis Jon Short, DO

  • Family Medicine Physician
  • Lansing, MI
National Provider Identifier
1073033197
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101023443 Issued in MI
Practice address
1200 E Michigan Ave Ste 245
Lansing, MI 48912-1897
Phone
(517) 364-5252
NPI assigned
Jun 20, 2017
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101023443 MI Primary

Addresses

Primary practice location

1200 E Michigan Ave Ste 245
Lansing, MI 48912-1897

Mailing address

1200 E Michigan Ave Ste 245
Lansing, MI 48912-1897
Phone (517) 364-5252

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
I20200519002704 MI Practitioner - Family Practice 8820429202 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

13191 Schavey Rd
Suite 3
Dewitt, MI 48820-9036
Phone (517) 669-9109

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5101023443MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Edward W Sparrow Hospital Association Family Medicine CurrentSince Jul 1, 2020 Accepting new patients
Edward W. Sparrow Hospital Association Current Accepting new patients
Edward W. Sparrow Hospital Association Family Medicine CurrentSince Jul 1, 2020 Accepting new patients
Edward W. Sparrow Hospital Association Current Accepting new patients
Edward W. Sparrow Hospital Association Past Accepting new patients

Locations

8175 Reliable Pkwy
Chicago, IL 60686

13191 Schavey Rd
Ste 3
Dewitt, MI 48820
Phone (517) 669-9109

2682 E Grand River Ave
East Lansing, MI 48823
Phone (517) 333-6352

1200 E Michigan Ave
Ste 245
Lansing, MI 48912
Phone (517) 364-5710

1215 E Michigan Ave
Lansing, MI 48912
Phone (517) 336-8080

800 E Columbia St
Mason, MI 48854
Phone (517) 244-8900

Organizations & group practices 5

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 5

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": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1073033197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 E MICHIGAN AVE STE 245",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489121897",
            "telephone_number": "517-364-5252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 E MICHIGAN AVE STE 245",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489121897",
            "telephone_number": "517-364-5252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHORT",
        "first_name": "TRAVIS",
        "middle_name": "JON",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-20",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101023443",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, MI

Sources for this page

Verify at the official NPI Registry.