NPIMap

Organization Active NPI

Digestive Health Associates of Northern Michigan, P.C.

  • Gastroenterology Physician
  • Traverse City, MI
National Provider Identifier
1225104011
Registry record updated Jun 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
Legal business name
DIGESTIVE HEALTH ASSOCIATES OF NORTHERN MICHIGAN, P.C.
Practice address
4100 Park Forest Dr
Suite 208
Traverse City, MI 49684-7331
Phone
(231) 935-5710
Fax
(231) 935-9045
NPI assigned
Nov 26, 2006
Last updated
Jun 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2008

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

Authorized official

Name
Ms. Gail E Eminhizer, CMM, MA
Title
Practice Administrator
Phone
(231) 935-9060

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X MI Primary

Addresses

Primary practice location

4100 Park Forest Dr
Suite 208
Traverse City, MI 49684-7331

Mailing address

4100 Park Forest Dr
Suite 208
Traverse City, MI 49684-7331
Phone (231) 935-5710

Other identifiers 1

IdentifierTypeStateIssuer
OB81010OtherMIBCBSM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040522000072 MI Part B Supplier - Clinic/Group Practice 2062403538 Receives reassigned benefits from 13 practitioners
Practice locations: Traverse City, MI

National Provider Directory

National Provider Directory

Locations

231191 Momentum Pl
Chicago, IL 60689

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1164499200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213574400000",
    "number": "1225104011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 PARK FOREST DR",
            "address_2": "SUITE 208",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847331",
            "telephone_number": "231-935-5710",
            "fax_number": "231-935-9045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 PARK FOREST DR",
            "address_2": "SUITE 208",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847331",
            "telephone_number": "231-935-5710",
            "fax_number": "231-935-9045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIGESTIVE HEALTH ASSOCIATES OF NORTHERN MICHIGAN, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-26",
        "last_updated": "2008-06-16",
        "status": "A",
        "authorized_official_last_name": "EMINHIZER",
        "authorized_official_first_name": "GAIL",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "231-935-9060",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CMM, MA"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "OB81010",
            "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 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.