NPIMap

Organization Active NPI

Novello Imaging PLC

  • Radiology Clinic/Center
  • Traverse City, MI
National Provider Identifier
1265030068
Registry record updated Oct 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Clinic/CenterTaxonomy code 261QR0200X
Legal business name
NOVELLO IMAGING PLC
Practice address
4290 Copper Ridge Dr Ste 100
Traverse City, MI 49684-7256
Phone
(231) 714-4306
Fax
(231) 714-0077
NPI assigned
Oct 14, 2020
Last updated
Oct 16, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2026

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

Authorized official

Name
Kris Elliott
Title
Authorized Official
Phone
(231) 421-8505

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Clinic/Center 261QR0200X NU Primary

Addresses

Primary practice location

4290 Copper Ridge Dr Ste 100
Traverse City, MI 49684-7256

Mailing address

4290 Copper Ridge Dr Ste 100
Traverse City, MI 49684-7256
Phone (314) 218-5052

Electronic endpoints 1

TypeEndpointUseAffiliation
FHIR URL https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/ Other Management Services Network, LLC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, TX, WA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20210222002022 MI Part B Supplier - Clinic/Group Practice 3476968686 Receives reassigned benefits from 26 practitioners
Practice locations: Traverse City, MI; Northville, MI; West Bloomfield, MI
O20230620003393 TX Part B Supplier - Clinic/Group Practice 3476968686 Receives reassigned benefits from 4 practitioners
Practice locations: Houston, TX; Spring, TX
O20251126003664 WA Part B Supplier - Clinic/Group Practice 3476968686 Receives reassigned benefits from 1 practitioner
Practice locations: Seattle, WA

National Provider Directory

National Provider Directory

Locations

200 Ottawa Ave NW
Grand Rapids, MI 49503

125 S Park St
Ste 300
Traverse City, MI 49684

4290 Copper Ridge Dr
Ste 100
Traverse City, MI 49684
Phone (231) 421-8505

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792108800000",
    "number": "1265030068",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4290 COPPER RIDGE DR STE 100",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847256",
            "telephone_number": "314-218-5052",
            "fax_number": "231-421-8506"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4290 COPPER RIDGE DR STE 100",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847256",
            "telephone_number": "231-714-4306",
            "fax_number": "231-714-0077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOVELLO IMAGING PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-14",
        "last_updated": "2026-10-16",
        "certification_date": "2026-10-16",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "KRIS",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "231-421-8505"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://cpiapigateway.cms.gov/api/esmdf/ext/v1/fhir/Practitioner/",
            "affiliation": "Y",
            "endpointDescription": "urn:oid:2.16.840.1.113883.3.1036.1",
            "affiliationName": "Management Services Network, LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2357 Warm Springs Rd Ste 400",
            "city": "Columbus",
            "state": "GA",
            "country_code": "US",
            "postal_code": "319046874",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Oct 16, 2026; 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.