Northern Michigan Gastroenterology PLC

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

4301052861 Issued in MI

Legal business name

NORTHERN MICHIGAN GASTROENTEROLOGY PLC

Practice address

224 Circle Dr
Traverse City, MI 49684-2342

Phone

(231) 935-0525

Fax

(231) 935-0529

NPI assigned

Jun 14, 2005

Organization subpart

No

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

Authorized official

Name

John P Milliken, M.D.NPI 1013048057

Title

President

Phone

(231) 935-0525

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Interoperability endpoints

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

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John P Milliken, MD

  • Gastroenterology Physician
  • Traverse City, MI
  • NPI 1013048057
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1118707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1295222400000",
    "number": "1659376077",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224 CIRCLE DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842342",
            "telephone_number": "231-935-0525",
            "fax_number": "231-935-0529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "224 CIRCLE DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842342",
            "telephone_number": "231-935-0525",
            "fax_number": "231-935-0529"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN MICHIGAN GASTROENTEROLOGY PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-14",
        "last_updated": "2011-01-17",
        "status": "A",
        "authorized_official_last_name": "MILLIKEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-935-0525",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "MI",
            "license": "4301052861",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "P89086",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10 4680183",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS BLUE SHIELD",
            "identifier": "10 02810491",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2011; 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.