NPIMap

Individual provider Active NPI

John William Stanifer, M.D.

  • Nephrology Physician
  • Traverse City, MI
National Provider Identifier
1427373232
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nephrology PhysicianTaxonomy code 207RN0300X
License
4301116578 Issued in MI
Practice address
4062 W Royal Dr
Traverse City, MI 49684-8965
Phone
(231) 935-0338
Fax
(231) 935-0569
NPI assigned
Apr 5, 2010
Last updated
Dec 8, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 2015-01272 NC
Nephrology Physician 207RN0300X 165219 NC
Nephrology Physician 207RN0300X 4301116578 MI Primary

Addresses

Primary practice location

4062 W Royal Dr
Traverse City, MI 49684-8965

Mailing address

1105 Sixth St
C/O Payer Enrollment
Traverse, MI 49684

Other practice location 1

419 S Coral St
Kalkaska, MI 49646-2503
Phone (231) 258-7530

Other practice location 2

829 N Center Ave Ste 210
Gaylord, MI 49735-1599
Phone (231) 935-0338

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address john.stanifer@meg.eclinicaldirectplus.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190116001297 MI Practitioner - NephrologyPractitioner - Internal Medicine 5294038725 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
NephrologyAlso: Internal Medicine
Education
University of Tennessee, HSC, College of Medicine, 2010
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

Practice addresses (Care Compare)

4062 W Royal Dr
Traverse City, MI 49684-8965
Phone (231) 935-0338

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2015-01272NCMDInternal Medicine Physician
165219NCMDNephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Center Current Accepting new patients
Munson Medical Center Nephrology CurrentSince Jan 1, 2019 Accepting new patients
Munson Medical Center CurrentSince Jan 1, 2019 Accepting new patients
Munson Medical Center Past Accepting new patients

Locations

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

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

829 N Center Ave
Ste 210
Gaylord, MI 49735
Phone (989) 731-7860

419 S Coral St
Kalkaska, MI 49646
Phone (231) 258-7500

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

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

3537 W Front St
Ste A
Traverse City, MI 49684
Phone (231) 935-2525

4062 W Royal Dr
Traverse City, MI 49684
Phone (231) 935-0338

Interoperability endpoints

  • Direct secure messaging: jstanifer@direct.mhc.net

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1270425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670457600000",
    "number": "1427373232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "address_2": "C/O PAYER ENROLLMENT",
            "city": "TRAVERSE",
            "state": "MI",
            "postal_code": "49684"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4062 W ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496848965",
            "telephone_number": "231-935-0338",
            "fax_number": "231-935-0569"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "419 S Coral St",
            "address_purpose": "LOCATION",
            "city": "Kalkaska",
            "state": "MI",
            "postal_code": "496462503",
            "country_code": "US",
            "telephone_number": "231-258-7530",
            "fax_number": "231-258-7555",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "829 N Center Ave Ste 210",
            "address_purpose": "LOCATION",
            "city": "Gaylord",
            "state": "MI",
            "postal_code": "497351599",
            "country_code": "US",
            "telephone_number": "231-935-0338",
            "fax_number": "231-935-0569",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STANIFER",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-04-05",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2015-01272",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "NC",
            "license": "165219",
            "primary": false
        },
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "MI",
            "license": "4301116578",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "john.stanifer@meg.eclinicaldirectplus.com",
            "affiliation": "N",
            "address_1": "4062 W Royal Dr",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496848965",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.