Kids Creek Childrens Clinic PC

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

Legal business name

KIDS CREEK CHILDRENS CLINIC PC

Practice address

5024 N Royal Dr
Traverse City, MI 49684-9230

Phone

(231) 935-0555

Fax

(231) 935-0562

NPI assigned

Jul 22, 2006

Last updated

Jun 27, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Angela Mullen

Title

Practice Administrator

Phone

(231) 935-0555

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/HBICCA

Practitioners 8

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.

• Kristina Anne Lishawa, M.D.

  • Pediatrics Physician
  • Traverse City, MI
  • NPI 1063425205
  Medicare reassignment Care Compare group NPD
• Rachel Beth Newman, M.D.

  • Pediatrics Physician
  • Charlevoix, MI
  • NPI 1013173392
  Medicare reassignment Care Compare group NPD
• James Wallace Robertson, MD

  • Pediatrics Physician
  • Traverse City, MI
  • NPI 1457357832
  Medicare reassignment Care Compare group NPD
• Elayna Hothem Dush-Bryant, MD

  • Pediatrics Physician
  • Grand Rapids, MI
  • NPI 1376063867
  Medicare reassignment NPD
• Stephanie Barbera Galdes, D.O.

  • Pediatrics Physician
  • Traverse City, MI
  • NPI 1396905881
  Medicare reassignment NPD
• Kimberly A Hegewald, MD

  • Pediatrics Physician
  • Traverse City, MI
  • NPI 1851379770
  Medicare reassignment NPD
• Mark D. Israel, M.D.

  • Pediatrics Physician
  • Lansing, MI
  • NPI 1396840369
  Medicare reassignment NPD
• Miranda Buist, FNP-C

  • Family Nurse Practitioner
  • Traverse City, MI
  • NPI 1245021138
  NPD (past)

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

{
    "created_epoch": "1153526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719446400000",
    "number": "1649291832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5024 N ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849230",
            "telephone_number": "231-935-0555",
            "fax_number": "231-935-0562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5024 N ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496849230",
            "telephone_number": "231-935-0555",
            "fax_number": "231-935-0562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS CREEK CHILDRENS CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-22",
        "last_updated": "2024-06-27",
        "certification_date": "2024-06-27",
        "status": "A",
        "authorized_official_last_name": "MULLEN",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "231-935-0555",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lynda Key, SW
• Brittnee Keyes, FNP
• Megan Jeane Keyes, BCBA, LBA
• Michael Joseph Keyes, PA-C
• Molly Kidner, FNP-BC
• Kids Creek Family Counseling, LLC
• Patrick J Kiella, OD
• Yelena Kier, D.O.
• Casey Lyne Kies, CHW
• Camilla Maria Kiessel

• Pediatrics Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Pediatrics Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.