Individual provider Active NPI

Kathryn Holmstrom-Baker, PA-C

  • Physician Assistant
  • Traverse City, MI
National Provider Identifier
1689824948
Registry record updated Apr 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601005399 Issued in MI
Practice address
4100 Park Forest Dr Ste 208
Traverse City, MI 49684-7306
Phone
(231) 935-5710
Fax
(231) 935-9045
NPI assigned
Sep 23, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601005399 MI Primary

Addresses

Primary practice location

4100 Park Forest Dr Ste 208
Traverse City, MI 49684-7306

Mailing address

1105 Sixth St
Traverse City, MI 49684-2345
Phone (231) 935-5710

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20081101000125 MI Practitioner - Physician Assistant 3375602634 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Munson Medical CenterGroup PAC ID 3072426287, 377 clinicians

Practice addresses (Care Compare)

1400 Medical Campus Dr
Traverse City, MI 49684-7823
Phone (231) 935-8000

4100 Park Forest Dr
Suite 208
Traverse City, MI 49684-7306
Phone (231) 935-5710

Hospital & facility affiliations

  • Munson Medical Center Hospital, Traverse City, MI, CCN 230097
  • Munson Healthcare Cadillac Hospital Hospital, Cadillac, MI, CCN 230081
  • Munson Healthcare Grayling Hospital Hospital, Grayling, MI, CCN 230058
  • Paul Oliver Memorial Hospital Hospital, Frankfort, MI, CCN 231300
  • Charlevoix Area Hospital Hospital, Charlevoix, MI, CCN 231322

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Center CurrentSince Jul 8, 2024 Accepting new patients
Musnon Medical Center CurrentSince Jul 8, 2024 Accepting new patients
Munson Medical Center Past Accepting new patients

Locations

1400 Medical Campus Dr
Traverse City, MI 49684
Phone (231) 935-8000

4100 Park Forest Dr
Ste 208
Traverse City, MI 49684
Phone (231) 392-8705

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

Organizations & group practices 5

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1222128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1713744000000",
    "number": "1689824948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842345",
            "telephone_number": "231-935-5710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 PARK FOREST DR STE 208",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847306",
            "telephone_number": "231-935-5710",
            "fax_number": "231-935-9045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMSTROM-BAKER",
        "first_name": "KATHRYN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-23",
        "last_updated": "2024-04-22",
        "certification_date": "2024-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601005399",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.