Daniel Racalla

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601011277 Issued in MI

Practice address

2545 Orchard Circle Dr Apt 4
Traverse City, MI 49686-1589

Phone

(989) 858-2410

NPI assigned

Aug 24, 2022

Last updated

Sep 28, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Crystal Lake Clinic PC

  • Family Medicine Physician
  • Manistee, MI
  • NPI 1134491731
  Medicare reassignment
• Crystal Lake Clinic P.C.

  • Family Medicine Physician
  • Suttons Bay, MI
  • NPI 1164945978
  NPD
• Crystal Lake Clinic, P.C.

  • Family Medicine Physician
  • Bear Lake, MI
  • NPI 1902851777
  NPD
• Crystal Lake Clinic, PC

  • Family Medicine Physician
  • Manton, MI
  • NPI 1306190475
  NPD (past)

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

{
    "created_epoch": "1661299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664323200000",
    "number": "1679292668",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2545 ORCHARD CIRCLE DR APT 4",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496861589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2545 ORCHARD CIRCLE DR APT 4",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496861589",
            "telephone_number": "989-858-2410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RACALLA",
        "first_name": "DANIEL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-08-24",
        "last_updated": "2022-09-28",
        "certification_date": "2022-09-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601011277",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derek E Pyne, DO
• Barbara J Quinn, ED.D.
• Julie Anne Quinn, MD
• Thomas Joseph Quinn, M.D.
• Alison Balmer Quiring, N.P.
• Francesca Racca
• Sarah Rademacher, LLMSW
• Sarah Beth Rader
• Dean Robert Raein, FNP
• Robert Burke Raetz, LPC

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.