Organization Active NPI

Bay Area Family Care of Traverse City PLC

  • Family Medicine Physician
  • Traverse City, MI
National Provider Identifier
1407858798
Registry record updated Apr 24, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101009568 Issued in MI
Legal business name
BAY AREA FAMILY CARE OF TRAVERSE CITY PLC
Practice address
906 Business Park Dr
Traverse City, MI 49686-8683
Phone
(231) 935-8755
NPI assigned
Jun 1, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2008

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

Authorized official

Name
Sally Miller, DO
Title
Partner
Phone
(231) 935-8755

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X 5101009568 MI Primary

Addresses

Primary practice location

906 Business Park Dr
Traverse City, MI 49686-8683

Mailing address

PO Box 3318
Grand Rapids, MI 49501-3318
Phone (800) 968-6866

Other identifiers 1

IdentifierTypeStateIssuer
DC7393OtherMIRAIL ROAD GROUP NUMBER

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040630000532 MI Part B Supplier - Clinic/Group Practice 9830176650 Receives reassigned benefits from 5 practitioners
Practice locations: Traverse City, MI

National Provider Directory

National Provider Directory

Locations

906 Business Park Dr
Traverse City, MI 49686
Phone (231) 933-6600

1899 Dracka Rd
Ste 100
Traverse City, MI 49685
Phone (231) 946-2999

550 Munson Ave
Ste 101
Traverse City, MI 49686
Phone (231) 935-8750

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208995200000",
    "number": "1407858798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3318",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495013318",
            "telephone_number": "800-968-6866",
            "fax_number": "616-532-7230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "906 BUSINESS PARK DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496868683",
            "telephone_number": "231-935-8755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAY AREA FAMILY CARE OF TRAVERSE CITY PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-01",
        "last_updated": "2008-04-24",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "SALLY",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "231-935-8755",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101009568",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD GROUP NUMBER",
            "identifier": "DC7393",
            "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 24, 2008; 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.