Active NPI
Thomas R Doerr, M.D.
- Plastic Surgery Physician
- Traverse City, MI
National Provider Identifier
1699886168
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- TD036578
- Practice address
- 213 S Madison St
Traverse City, MI 49684-2321 - Phone
- (231) 947-0220
- Fax
- (231) 947-1629
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | TD036578 | MI | Primary |
Addresses
Primary practice location
213 S Madison St
Traverse City, MI 49684-2321
Mailing address
213 S Madison St
Traverse City, MI 49684-2321
Phone (231) 947-0220
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2402800852 | Other | MI | BLUE CROSS BLUE SHIELD |
| 2402800852 | Other | MI | BLUE CARE NETWORK |
| 900003054 | Other | MI | PRIORITY HEALTH |
| 2120993 | Medicaid | MI | |
| 382629298 | Other | MI | TRICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| TD036578 | MI | MD | Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272585600000",
"number": "1699886168",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "213 S MADISON ST",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496842321",
"telephone_number": "231-947-0220",
"fax_number": "231-947-1629"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "213 S MADISON ST",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496842321",
"telephone_number": "231-947-0220",
"fax_number": "231-947-1629"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOERR",
"first_name": "THOMAS",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2010-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "MI",
"license": "TD036578",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "2402800852",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CARE NETWORK",
"identifier": "2402800852",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PRIORITY HEALTH",
"identifier": "900003054",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2120993",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "382629298",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.