Organization Active NPI

Rising Star Wellness Center PLC

  • Family Medicine Physician
  • Traverse City, MI
National Provider Identifier
1215988845
Registry record updated Jun 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
RISING STAR WELLNESS CENTER PLC
Practice address
3189 Logan Valley Rd
Traverse City, MI 49684-4772
Phone
(231) 932-1988
NPI assigned
May 16, 2006
Last updated
Jun 14, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 14, 2013

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

Authorized official

Name
Flora Ermenia Biancalana, MDNPI 1649238098
Title
Owner
Phone
(231) 932-1988

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

3189 Logan Valley Rd
Traverse City, MI 49684-4772

Mailing address

3189 Logan Valley Rd
Traverse City, MI 49684-4772
Phone (231) 932-1988

Other identifiers 1

IdentifierTypeStateIssuer
4291443 10MedicaidMI

National Provider Directory

National Provider Directory

Locations

3250 Racquet Club Dr
Traverse City, MI 49684
Phone (231) 932-1988

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1371168000000",
    "number": "1215988845",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3189 LOGAN VALLEY RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496844772",
            "telephone_number": "231-932-1988"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3189 LOGAN VALLEY RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496844772",
            "telephone_number": "231-932-1988"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RISING STAR WELLNESS CENTER PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-16",
        "last_updated": "2013-06-14",
        "status": "A",
        "authorized_official_last_name": "BIANCALANA",
        "authorized_official_first_name": "FLORA",
        "authorized_official_middle_name": "ERMENIA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "231-932-1988",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4291443 10",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.