Individual provider Active NPI

Ashley Marie Goss, FNP-C

  • Family Nurse Practitioner
  • Interlochen, MI
National Provider Identifier
1306432059
Registry record updated Feb 26, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
4704297822 Issued in MI
Practice address
1975 Stirling Dr
Interlochen, MI 49643-9264
Phone
(231) 275-7965
NPI assigned
Dec 16, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 4704297822 MI Primary

Addresses

Primary practice location

1975 Stirling Dr
Interlochen, MI 49643-9264

Mailing address

6227 Frankfort Hwy
Benzonia, MI 49616-8632
Phone (231) 882-9661

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
I20210303001793 MI Practitioner - Nurse Practitioner 3476969247 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
4704297822MIMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Crystal Lake Clinic PC Current Accepting new patients
Crystal Lake Clinic P.C. CurrentSince Feb 22, 2021 Accepting new patients
Crystal Lake Clinic P.C. CurrentSince Feb 22, 2021 Accepting new patients
Crystal Lake Clinic, P.C. Past Accepting new patients
Crystal Lake Clinic P.C. Past Accepting new patients
Chronic Care Management LLC PastSince Dec 1, 2020 Accepting new patients

Locations

6227 Frankfort Hwy
Benzonia, MI 49616
Phone (231) 882-9661

1975 Stirling Dr
Interlochen, MI 49643
Phone (231) 275-0166

4025 Chums Village Dr
Traverse City, MI 49685
Phone (231) 252-3433

Interoperability endpoints

  • Direct secure messaging: ashleygoss@clhcmi.allscriptsdirect.net

Organizations & group practices 6

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": "1608076800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614297600000",
    "number": "1306432059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6227 FRANKFORT HWY",
            "city": "BENZONIA",
            "state": "MI",
            "postal_code": "496168632",
            "telephone_number": "231-882-9661",
            "fax_number": "231-882-9616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1975 STIRLING DR",
            "city": "INTERLOCHEN",
            "state": "MI",
            "postal_code": "496439264",
            "telephone_number": "231-275-7965"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOSS",
        "first_name": "ASHLEY",
        "middle_name": "MARIE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-16",
        "last_updated": "2021-02-26",
        "certification_date": "2021-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704297822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Interlochen, MI

Sources for this page

Verify at the official NPI Registry.