NPIMap

Individual provider Active NPI

Kevin A Brokaw, PA-C

  • Physician Assistant
  • Traverse City, MI
National Provider Identifier
1487714531
Registry record updated Jul 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004361 Issued in MI
Practice address
1105 Sixth St
Traverse City, MI 49684-2345
Phone
(231) 935-7514
Fax
(231) 392-0039
NPI assigned
Dec 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2024

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 5601004361 MI Primary

Addresses

Primary practice location

1105 Sixth St
Traverse City, MI 49684-2345

Mailing address

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

Other practice location 1

3074 N US 31 S
Traverse City, MI 49684-4533
Phone (231) 929-1234

Other practice location 2

5087 N Royal Dr Ste B
Traverse City, MI 49684-6987
Phone (231) 935-0440

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
I20041208000156 MI Practitioner - Physician Assistant 9436115763 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2004
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

1400 Medical Campus Dr
Traverse City, MI 49684-7823
Phone (231) 935-8000

Hospital & facility affiliations

  • Munson Medical Center Hospital, Traverse City, MI, CCN 230097
  • Kalkaska Memorial Health Center Hospital, Kalkaska, MI, CCN 231301

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 Aug 10, 2020 Accepting new patients
Munson Medical Center CurrentSince May 6, 2024 Accepting new patients
Partners in Health of Traverse City Past Accepting new patients
Urgent Care of Traverse City PLLC Past Accepting new patients
Munson Medical Center Past Accepting new patients
Gregory G North PHD PC PastSince Jan 15, 2003 Accepting new patients

Locations

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

3074 US 31 S
Traverse City, MI 49684
Phone (231) 642-5419

5087 N Royal Dr
Ste B
Traverse City, MI 49684
Phone (231) 935-0440

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

Organizations & group practices 17

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.

View all 17

Hospital & facility affiliations 2

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": "1165795200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720137600000",
    "number": "1487714531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842345",
            "telephone_number": "231-935-7514",
            "fax_number": "231-392-0039"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842345",
            "telephone_number": "231-935-7514",
            "fax_number": "231-392-0039"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3074 N US 31 S",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496844533",
            "country_code": "US",
            "telephone_number": "231-929-1234",
            "fax_number": "231-929-1234",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "5087 N Royal Dr Ste B",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496846987",
            "country_code": "US",
            "telephone_number": "231-935-0440",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BROKAW",
        "first_name": "KEVIN",
        "middle_name": "A",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-11",
        "last_updated": "2024-07-05",
        "certification_date": "2024-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004361",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.