Mary Kathryn Douglas, PAC

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

MD003850 Issued in MI

Practice address

3074 N US 31 S
Traverse City, MI 49684-4533

Phone

(231) 929-1234

NPI assigned

Aug 9, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

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: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Munson Medical CenterGroup PAC ID 3072426287, 377 clinicians

True North Medical PCGroup PAC ID 7315487790, 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Munson Medical Center Hospital, Traverse City, MI, CCN 230097

Merit-based Incentive Payment System (MIPS)

Final score

100 of 100Reported as group

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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

• True North Medical PC

  • Urgent Care Clinic/Center
  • Traverse City, MI
  • NPI 1295564391
  Medicare reassignment Care Compare group NPD
• Munson Medical Center

  • Endocrinology, Diabetes & Metabolism Physician
  • Traverse City, MI
  • NPI 1083761860
  Medicare reassignment Care Compare group
• Munson Medical Center

  • Internal Medicine Physician
  • Traverse City, MI
  • NPI 1205864220
  NPD
• Munson Medical Center

  • Psychiatric Hospital Unit
  • Traverse City, MI
  • NPI 1891586103
  NPD
• Munson Medical Center

  • Family Medicine Physician
  • Traverse City, MI
  • NPI 1881623031
  NPD (past)

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

• Munson Medical Center

  • General Acute Care Hospital
  • Traverse City, MI
  • NPI 1952307852
  Care Compare affiliation

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

{
    "created_epoch": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1114928637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3074 N US 31 S",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496844533",
            "telephone_number": "231-929-1234",
            "fax_number": "231-935-0984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3074 N US 31 S",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496844533",
            "telephone_number": "231-929-1234"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "550 Munson Ave",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496863580",
            "country_code": "US",
            "telephone_number": "231-935-8686",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1105 Sixth St",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496842345",
            "country_code": "US",
            "telephone_number": "231-935-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOUGLAS",
        "first_name": "MARY",
        "middle_name": "KATHRYN",
        "name_prefix": "Ms.",
        "credential": "PAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-09",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "MI",
            "license": "MD003850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelly R Donovan, DO
• Andrew Doorn, PA-C
• Daniel James Dorrance
• Robert M Dotterrer, MD
• Carrie Douglas
• Bruce G Douglass, PHD
• Katharine C Douglass, M.S.
• Nancy Dow
• Megan Anne Downer, M.A., CCC-SLP, CLC
• Samantha Louise Doyle

• Medical Physician Assistant in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Medical Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.