NPIMap

Individual provider Active NPI

Kathryn S Shaffer, M.D.

  • Family Medicine Physician
  • Traverse City, MI
National Provider Identifier
1487940631
Registry record updated Dec 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301099198 Issued in MI
Practice address
1400 Medical Campus Dr
Traverse City, MI 49684-7823
Phone
(231) 935-8000
Fax
(231) 935-8099
NPI assigned
Jun 27, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 29, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 4301099198 MI Primary

Addresses

Primary practice location

1400 Medical Campus Dr
Traverse City, MI 49684-7823

Mailing address

2513 Momentum PL
Chicago, IL 60689-5325
Phone (231) 935-6080

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kshaffer@direct.mhc.net

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
I20140730001840 MI Practitioner - Family Practice 4688890494 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Munson Medical GroupGroup PAC ID 8820277015, 191 clinicians

Practice addresses (Care Compare)

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
  • Munson Healthcare Cadillac Hospital Hospital, Cadillac, MI, CCN 230081

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal or shaving of skin growth1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Group CurrentSince Jan 1, 2020 Accepting new patients
Munson Medical Center CurrentSince Jan 18, 2017 Accepting new patients
Munson Medical Group Current Accepting new patients
Munson Medical Center Family Medicine CurrentSince Jan 18, 2017 Accepting new patients
Munson Medical Group Family Medicine CurrentSince Jan 1, 2020 Accepting new patients
Munson Medical Center Current Accepting new patients
Munson Medical Center Family Medicine Past Accepting new patients
Munson Medical Center Past Accepting new patients
Munson Healthcare Cadillac PastSince Nov 7, 2025 Accepting new patients

Locations

2891 Momentum Pl
Chicago, IL 60689

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

1105 Sixth St
Ste D6
Traverse City, MI 49684
Phone (231) 935-6380

1200 Sixth St
Ste 200
Traverse City, MI 49684

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

Interoperability endpoints

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

Organizations & group practices 9

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 3

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": "1309132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609200000000",
    "number": "1487940631",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2513 MOMENTUM PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606895325",
            "telephone_number": "231-935-6080",
            "fax_number": "231-935-6081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MEDICAL CAMPUS DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847823",
            "telephone_number": "231-935-8000",
            "fax_number": "231-935-8099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "KATHRYN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-27",
        "last_updated": "2020-12-29",
        "certification_date": "2020-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301099198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kshaffer@direct.mhc.net",
            "affiliation": "N",
            "address_1": "1400 Medical Campus Dr",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496847823",
            "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.