Traci J Van Gorden, CFNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704252117 Issued in MI

Practice address

104 S Lakeview Ave
Sturgis, MI 49091-1947

Phone

(269) 319-8850

Fax

(269) 464-0101

NPI assigned

Jun 8, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI, IN2 enrollments

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 2

Specialty

Nurse Practitioner

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fast Pace Medical Clinic PLLCGroup PAC ID 5395881841, 737 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Fast Pace Medical Clinic PLLC

  • Family Medicine Physician
  • Hanover, IN
  • NPI 1649770769
  Medicare reassignment Care Compare group NPD
• Revolution Health PC

  • Primary Care Clinic/Center
  • Sturgis, MI
  • NPI 1366091670
  Medicare reassignment NPD
• FC Indiana, LLC

  • Nurse Practitioner
  • Bedford, IN
  • NPI 1225579063
  Medicare reassignment NPD
• Hometown Urgent Care of Michigan, P.C.

  • Urgent Care Clinic/Center
  • Huber Heights, OH
  • NPI 1790030385

  MI

  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  MI

  Medicare reassignment
• Hometown Urgent Care of Michigan, P.C.

  • Clinical Medical Laboratory
  • Kalamazoo, MI
  • NPI 1891469631
  NPD
• Revolution Health PC

  • Primary Care Clinic/Center
  • Colon, MI
  • NPI 1881359180
  NPD
• Fast Pace Medical Clinic PLLC

  • Rural Health Clinic/Center
  • Chapel Hill, TN
  • NPI 1316602774
  NPD
• FC Indiana, LLC

  • Rural Health Clinic/Center
  • Bedford, IN
  • NPI 1841911591
  NPD
• Hometown Urgent Care of Michigan, PC

  • Clinical Medical Laboratory
  • Indianapolis, IN
  • NPI 1881358489
  NPD
• Upperline Healthcare, PC

  • Foot & Ankle Surgery Podiatrist
  • Hoover, AL
  • NPI 1538686498
  NPD
• Sturgis Hospital, Inc.

  • Surgery Physician
  • Sturgis, MI
  • NPI 1376226159
  NPD (past)

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

{
    "created_epoch": "1149724800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604534400000",
    "number": "1679513451",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 S LAKEVIEW AVE",
            "city": "STURGIS",
            "state": "MI",
            "postal_code": "490911947",
            "telephone_number": "269-319-8850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 S LAKEVIEW AVE",
            "city": "STURGIS",
            "state": "MI",
            "postal_code": "490911947",
            "telephone_number": "269-319-8850",
            "fax_number": "269-464-0101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN GORDEN",
        "first_name": "TRACI",
        "middle_name": "J",
        "credential": "CFNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-08",
        "last_updated": "2020-11-05",
        "certification_date": "2020-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704252117",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4888010",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4887990",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathryn Boegel Tiefenthal, M.S.W.
• Miranda Todd, DMD
• Trail Finders PLLC
• Benjamin Travers, MD
• Trevor Neal DPM
• Ashley Vanaman
• Kathleen Lynn Vandenbos, PHARMACY TECHNICIAN
• Ashish Verma, M.D.
• Vicente D Cabansag Jr MD PC
• Alyssa Vowels

• Family Nurse Practitioner in Sturgis, MI
• Providers in Sturgis, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2020; 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.
• 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.