Grand Traverse Pavilions

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

GRAND TRAVERSE PAVILIONS

Practice address

1000 Pavilions Circle
Traverse City, MI 49684

Phone

(231) 932-3000

NPI assigned

Mar 15, 2007

Last updated

Feb 21, 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

Emily Ball

Title

Business Office Manager

Phone

(231) 932-3063

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1649304270. Details of each certification follow.

• CCN 236838 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 236838

Legal name

GRAND TRAVERSE PAVILIONS

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Apr 15, 2004

Last certification

Apr 4, 2025

Ownership / control type

Local Government

Facility address

1000 Pavilions Circle
Traverse City, MI 49684

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

CLIA laboratory certificates

Subparts reporting this organization as parent 2

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Grand Traverse Pavilions Home Healthcare

  • Home Health Agency
  • Traverse City, MI
  • NPI 1972802908
  NPPES parent name
• Pace North

  • PACE Provider Organization
  • Traverse City, MI
  • NPI 1194283846
  NPPES parent name

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1708473600000",
    "number": "1649304270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 PAVILIONS CIRCLE",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49684",
            "telephone_number": "231-932-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 PAVILIONS CIRCLE",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49684",
            "telephone_number": "231-932-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND TRAVERSE PAVILIONS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-15",
        "last_updated": "2024-02-21",
        "certification_date": "2024-02-21",
        "status": "A",
        "authorized_official_last_name": "BALL",
        "authorized_official_first_name": "EMILY",
        "authorized_official_title_or_position": "BUSINESS OFFICE MANAGER",
        "authorized_official_telephone_number": "231-932-3063"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS NUMBER",
            "identifier": "30395",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Grand Traverse Nutrition, LLC
• Grand Traverse Ophthalmology Clinic PC
• Grand Traverse Oral Surgery, P.C.
• Grand Traverse Orthopedics PLLC
• Grand Traverse Pathology, PLLC
• Grand Traverse Pavilions Home Healthcare
• Grand Traverse Physical Therapy, P.C.
• Grand Traverse Physician Services PC
• Grand Traverse Primary Care PLC
• Grand Traverse Radiologists PC

• Rehabilitation Clinic/Center in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Rehabilitation Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• 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.