Individual provider Active NPI

Mary Priestly

  • Physician Assistant
  • Traverse City, MI
National Provider Identifier
1346807617
Registry record updated Oct 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Practice address
550 Munson Ave
Traverse City, MI 49686-3580
Phone
(231) 935-8686
NPI assigned
May 22, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2019

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 Primary

Addresses

Primary practice location

550 Munson Ave
Traverse City, MI 49686-3580

Mailing address

7079 Cherrywood CT
Traverse City, MI 49686-1812
Phone (231) 463-1756

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
I20190703002690 MI Practitioner - Physician Assistant 4183959695 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Munson Medical CenterGroup PAC ID 3072426287, 377 clinicians

Practice addresses (Care Compare)

1105 6TH St
Traverse City, MI 49684-2345
Phone (231) 935-5000

1121 6TH St
Suite 316
Traverse City, MI 49684-2345
Phone (231) 392-8280

550 Munson Ave
Traverse City, MI 49686-3580
Phone (231) 935-2686

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Center CurrentSince Jun 16, 2019 Accepting new patients

Locations

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

1400 Medical Campus Dr
Traverse City, MI 49684
Phone (231) 935-8000

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

550 Munson Ave
Traverse City, MI 49686
Phone (231) 935-6600

Organizations & group practices 2

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 1

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": "1558483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1571875200000",
    "number": "1346807617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7079 CHERRYWOOD CT",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496861812",
            "telephone_number": "231-463-1756"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 MUNSON AVE",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863580",
            "telephone_number": "231-935-8686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRIESTLY",
        "first_name": "MARY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-05-22",
        "last_updated": "2019-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.