Individual provider Active NPI

Tina M Crook, PA-C

  • Physician Assistant
  • Petoskey, MI
National Provider Identifier
1285659953
Registry record updated May 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004367 Issued in MI
Practice address
4170 Cedar Bluff Dr.
Petoskey, MI 49770
Phone
(231) 487-2230
Fax
(231) 487-6172
NPI assigned
Jul 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601004367 MI Primary

Addresses

Primary practice location

4170 Cedar Bluff Dr.
Petoskey, MI 49770

Mailing address

4170 Cedar Bluff Dr
Petoskey, MI 49770-9600
Phone (231) 487-2230

Other identifiers 1

IdentifierTypeStateIssuer
5601004367OtherMIPHSYICIAN ASSISTANT LICEN

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
I20060831000450 MI Practitioner - Physician Assistant 3678577731 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Advanced Dermatology of Michigan PCGroup PAC ID 0941511224, 40 clinicians

Practice addresses (Care Compare)

13450 E 12 Mile Rd
Warren, MI 48088-3671
Phone (586) 759-5525

4170 Cedar Bluff Dr
Petoskey, MI 49770-7627
Phone (231) 487-2230

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
81.43
Promoting interoperability
82
Improvement activities
40
Cost
80.91

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Interoperability endpoints

  • Direct secure messaging: tina.crook@adcs1.emadirect.md

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.

Hospital & facility affiliations 4

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": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1368662400000",
    "number": "1285659953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4170 CEDAR BLUFF DR",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497709600",
            "telephone_number": "231-487-2230",
            "fax_number": "231-487-6172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4170 CEDAR BLUFF DR.",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "49770",
            "telephone_number": "231-487-2230",
            "fax_number": "231-487-6172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CROOK",
        "first_name": "TINA",
        "middle_name": "M",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-13",
        "last_updated": "2013-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHSYICIAN ASSISTANT LICEN",
            "identifier": "5601004367",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

Verify at the official NPI Registry.