Individual provider Active NPI

Alycia Rae Dzierwa, FNP-C

  • Family Nurse Practitioner
  • Traverse City, MI
National Provider Identifier
1184452815
Registry record updated Sep 17, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704369243 Issued in MI
Practice address
1105 Sixth St
Traverse City, MI 49684-2386
Phone
(231) 935-5000
NPI assigned
Jul 24, 2024
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704369243 MI Primary

Addresses

Primary practice location

1105 Sixth St
Traverse City, MI 49684-2386

Mailing address

9775 E Jennings Dr
Traverse City, MI 49684-2721
Phone (231) 357-6385

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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241206000243 MI Practitioner - Nurse Practitioner 7911433545 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Saginaw Valley Medical College - NLG, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cherry Bend Family Care, PLCGroup PAC ID 9032114624, 4 clinicians
Grand Traverse Physician Services PCGroup PAC ID 2466963806, 119 clinicians

Practice addresses (Care Compare)

10223 E Cherry Bend Rd
Cherry Bend Family Care
Traverse City, MI 49684-7304
Phone (231) 929-7933

1105 6TH St
Traverse City, MI 49684-2345
Phone (231) 935-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sound Inpatient Physicians-Michigan, PLLC CurrentSince Oct 3, 2024 Accepting new patients
Cherry Bend Family Care, PLC CurrentSince Jun 2, 2025 Accepting new patients
Grand Traverse Physician Services PC CurrentSince Jul 1, 2025 Accepting new patients
Sound Inpatient Physicians - Michigan, PLLC CurrentSince Oct 3, 2024 Accepting new patients

Locations

400 Hobart St
Cadillac, MI 49601
Phone (231) 876-7200

580 W College Ave
Marquette, MI 49855
Phone (906) 225-3131

10223 E Cherry Bend Rd
Traverse City, MI 49684
Phone (231) 929-7933

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

120 Brentwood Commons Way
Ste 510
Brentwood, TN 37027
Phone (253) 682-6040

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/JDAHAA

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1721779200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726531200000",
    "number": "1184452815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9775 E JENNINGS DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842721",
            "telephone_number": "231-357-6385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842386",
            "telephone_number": "231-935-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DZIERWA",
        "first_name": "ALYCIA",
        "middle_name": "RAE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-07-24",
        "last_updated": "2024-09-17",
        "certification_date": "2024-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704369243",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.