Individual provider Active NPI

Kevin Harris, MD

  • Surgery Physician
  • Traverse City, MI
National Provider Identifier
1366804593
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301508312 Issued in MI
Practice address
1221 Sixth St Ste 300
Traverse City, MI 49684-2360
Phone
(231) 935-2400
Fax
(231) 935-2424
NPI assigned
Mar 26, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301508312 MI Primary
Surgery Physician 208600000X A172505 CA

Addresses

Primary practice location

1221 Sixth St Ste 300
Traverse City, MI 49684-2360

Mailing address

1221 Sixth St Ste 300
Traverse City, MI 49684-2360
Phone (231) 935-2400

Other practice location 1

4100 Park Forest Dr
Traverse City, MI 49684-7331
Phone (231) 392-8900

Other practice location 2

1105 Sixth St
Traverse City, MI 49684-2345
Phone (231) 935-7514

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: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221223000768 MI Practitioner - General Surgery 3072805241 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Michigan State University College of Human Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Munson Medical CenterGroup PAC ID 3072426287, 377 clinicians
Munson Healthcare Charlevoix HospitalGroup PAC ID 4284528035, shared by 6 NPIs, 57 clinicians

Practice addresses (Care Compare)

1221 6TH St
Suite 306
Traverse City, MI 49684-2361
Phone (231) 935-2400

223 N Park St
Boyne City, MI 49712-1220
Phone (231) 582-5314

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

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

Merit-based Incentive Payment System (MIPS)

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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux19
Removal of tissue1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A172505CAMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Center Current Accepting new patients
Munson Medical Center CurrentSince Jan 3, 2023 Accepting new patients
Munson Medical Center CurrentSince Jan 3, 2023 Accepting new patients
Munson Medical Center Past Accepting new patients
Munson Medical Center Past Accepting new patients
Munson Medical Center Past Accepting new patients

Locations

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

4100 Park Forest Dr
Traverse City, MI 49684
Phone (231) 392-8900

1221 Sixth St
Ste 300
Traverse City, MI 49684
Phone (231) 392-0640

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

1221 Sixth St
Ste 306
Traverse City, MI 49684
Phone (231) 935-2400

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

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.

Hospital & facility affiliations 6

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": "1458950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1366804593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 SIXTH ST STE 300",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842360",
            "telephone_number": "231-935-2400",
            "fax_number": "231-935-2424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 SIXTH ST STE 300",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842360",
            "telephone_number": "231-935-2400",
            "fax_number": "231-935-2424"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4100 Park Forest Dr",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496847331",
            "country_code": "US",
            "telephone_number": "231-392-8900",
            "fax_number": "231-392-8973",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1105 Sixth St",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496842345",
            "country_code": "US",
            "telephone_number": "231-935-7514",
            "fax_number": "231-392-0039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "KEVIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-26",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301508312",
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "CA",
            "license": "A172505",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.