NPIMap

Organization Active NPI

Apollo Medical Group of Traverse City PLLC

  • Anesthesiology Physician
  • Traverse City, MI
National Provider Identifier
1467093153
Registry record updated Apr 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
APOLLO MEDICAL GROUP OF TRAVERSE CITY PLLC
Practice address
3663 N Country Dr
Traverse City, MI 49684-4587
Phone
(866) 888-8510
NPI assigned
Oct 3, 2019
Last updated
Apr 5, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2023

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

Authorized official

Name
Robin Van Sprundel
Title
Director of Administration
Phone
(941) 725-1198

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

3663 N Country Dr
Traverse City, MI 49684-4587

Mailing address

PO Box 4406
Springfield, IL 62708-4406
Phone (866) 888-8510

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191221000053 MI Part B Supplier - Clinic/Group Practice 8123452331 Receives reassigned benefits from 23 practitioners
Practice locations: Traverse City, MI

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 23

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 23

NPI Registry JSON

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

{
    "created_epoch": "1570060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680652800000",
    "number": "1467093153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4406",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627084406",
            "telephone_number": "866-888-8510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3663 N COUNTRY DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496844587",
            "telephone_number": "866-888-8510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "APOLLO MEDICAL GROUP OF TRAVERSE CITY PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-03",
        "last_updated": "2023-04-05",
        "certification_date": "2023-04-05",
        "status": "A",
        "authorized_official_last_name": "VAN SPRUNDEL",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_title_or_position": "DIRECTOR OF ADMINISTRATION",
        "authorized_official_telephone_number": "941-725-1198"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "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 5, 2023; 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.