Individual provider Active NPI

Laura Joan Gottfried, MD

  • Anatomic Pathology & Clinical Pathology Physician
  • Traverse City, MI
National Provider Identifier
1205850088
Registry record updated Sep 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
4301057575 Issued in MI
Practice address
1105 6TH St
Traverse City, MI 49684-2345
Phone
(231) 935-0499
NPI assigned
Jul 26, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 18, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X 4301057575 MI Primary

Addresses

Primary practice location

1105 6TH St
Traverse City, MI 49684-2345

Mailing address

PO Box 209
Lima, OH 45802-0209
Phone (866) 942-0836

Other practice location 1

400 Hobart St
Cadillac, MI 49601-2331
Phone (231) 876-7200

Other identifiers 2

IdentifierTypeStateIssuer
4110029MedicaidMI
220025505OtherMIRAILROAD MEDICARE

Other names 1

  • Dr. Laura Joan Schaub Former name

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100818000243 MI Practitioner - Pathology 4385718246 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
94.14 of 100Reported as group
Quality
88.27
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4301057575MIMDAnatomic Pathology & Clinical Pathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Traverse Pathology, PLLC Anatomic Pathology & Clinical Pathology CurrentSince Jul 12, 1999 Accepting new patients

Locations

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

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

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694995200000",
    "number": "1205850088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 209",
            "city": "LIMA",
            "state": "OH",
            "postal_code": "458020209",
            "telephone_number": "866-942-0836",
            "fax_number": "419-223-2726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 6TH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842345",
            "telephone_number": "231-935-0499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Hobart St",
            "address_purpose": "LOCATION",
            "city": "Cadillac",
            "state": "MI",
            "postal_code": "496012331",
            "country_code": "US",
            "telephone_number": "231-876-7200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOTTFRIED",
        "first_name": "LAURA",
        "middle_name": "JOAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-26",
        "last_updated": "2023-09-18",
        "certification_date": "2023-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "MI",
            "license": "4301057575",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4110029",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "220025505",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURA",
            "last_name": "SCHAUB",
            "middle_name": "JOAN",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.