Crystal Lake Clinic P.C.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CRYSTAL LAKE CLINIC P.C.

Practice address

1225 W Front St
Suite C
Traverse City, MI 49684-2368

Phone

(231) 715-3601

NPI assigned

Jul 18, 2015

Organization subpart

No

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

Authorized official

Name

Richard C Nielsen, M.D.

Title

President

Phone

(231) 882-9661

Specialties & licenses 1

Addresses

Tax ID family

Crystal Lake Clinic PC5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

• Crystal Lake Clinic P.C.

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

  • Family Medicine Physician
  • Traverse City, MI
  • NPI 1376927756
  NPD tax ID
• Crystal Lake Clinic, PC

  • Family Medicine Physician
  • Manton, MI
  • NPI 1306190475
  NPD tax ID
• Crystal Lake Clinic, PC

  • Family Medicine Physician
  • Traverse City, MI
  • NPI 1679844849
  NPD tax ID

Locations

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

{
    "created_epoch": "1437177600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1437177600000",
    "number": "1679957617",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6227 FRANKFORT HWY",
            "city": "BENZONIA",
            "state": "MI",
            "postal_code": "496168632",
            "telephone_number": "231-882-9661",
            "fax_number": "231-882-9616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1225 W FRONT ST",
            "address_2": "SUITE C",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842368",
            "telephone_number": "231-715-3601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL LAKE CLINIC P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-18",
        "last_updated": "2015-07-18",
        "status": "A",
        "authorized_official_last_name": "NIELSEN",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-882-9661",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Madison Crowe
• Sarah Crowley
• Nancy Ann Crummel, FNP
• Crystal Lake Clinic P.C.
• Crystal Lake Clinic P.C.
• Crystal Lake Clinic, PC
• Crystal Thomas, Llmsw
• Culver Meadows Afc, Inc.
• Culver Senior Living, Inc.
• Curtis A Cummins, M.D.

• Family Medicine Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.