NPIMap

Organization Active NPI

Grand Traverse Pathology, PLLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Traverse City, MI
National Provider Identifier
1306868427
Registry record updated Apr 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
Legal business name
GRAND TRAVERSE PATHOLOGY, PLLC
Practice address
1105 6TH St
Traverse City, MI 49684-2345
Phone
(231) 935-0499
NPI assigned
Jul 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2025

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

Authorized official

Name
Dr. Amy W Ferguson, MDNPI 1649380387
Title
President
Phone
(231) 935-6108

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X Primary

Addresses

Primary practice location

1105 6TH St
Traverse City, MI 49684-2345

Mailing address

PO Box 9099
Longview, TX 75608-9099
Phone (903) 663-4800

Other practice location 1

400 Hobart St
Cadillac, MI 49601-2331
Phone (231) 876-7200

Other identifiers 8

IdentifierTypeStateIssuer
510047OtherMIPREFERRED CHOICES
820OtherMIPRIORITY HEALTH
CB1092OtherMIRAILROAD MEDICARE
0B87602OtherMIBCBS
36478OtherMICOMMUNITY CHOICE OF MI
018175OtherMIMIDWEST HEALTH PLAN
53481AOtherMIHEALTH ALLIANCE PLAN
XX01516OtherMIHEALTHPLUS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080808000442 MI Part B Supplier - Clinic/Group Practice 4183798135 Receives reassigned benefits from 13 practitioners
Practice locations: Cadillac, MI; Traverse City, MI

National Provider Directory

National Provider Directory

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": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1744675200000",
    "number": "1306868427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9099",
            "city": "LONGVIEW",
            "state": "TX",
            "postal_code": "756089099",
            "telephone_number": "903-663-4800",
            "fax_number": "419-223-2726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 6TH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842345",
            "telephone_number": "231-935-0499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 Hobart St",
            "address_purpose": "LOCATION",
            "city": "Cadillac",
            "state": "MI",
            "postal_code": "496012331",
            "country_code": "US",
            "telephone_number": "231-876-7200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GRAND TRAVERSE PATHOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2025-04-15",
        "certification_date": "2025-04-15",
        "status": "A",
        "authorized_official_last_name": "FERGUSON",
        "authorized_official_first_name": "AMY",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-935-6108",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CHOICES",
            "identifier": "510047",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY HEALTH",
            "identifier": "820",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CB1092",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0B87602",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY CHOICE OF MI",
            "identifier": "36478",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDWEST HEALTH PLAN",
            "identifier": "018175",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE PLAN",
            "identifier": "53481A",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPLUS",
            "identifier": "XX01516",
            "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 Apr 15, 2025; 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.