Great Lakes Sports Medicine and Concussion Clinic

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

GREAT LAKES SPORTS MEDICINE AND CONCUSSION CLINIC

Practice address

3906 Stonegate Park Ste a
Saint Joseph, MI 49085-9145

Phone

(269) 408-1644

Fax

(269) 428-0019

NPI assigned

Mar 29, 2016

Last updated

Mar 29, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Christopher Trigger, M.D

Title

Owner

Phone

(269) 408-1644

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1459209600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459209600000",
    "number": "1720441728",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3906 STONEGATE PARK STE A",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859145",
            "telephone_number": "269-408-1644",
            "fax_number": "269-428-0019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3906 STONEGATE PARK STE A",
            "city": "SAINT JOSEPH",
            "state": "MI",
            "postal_code": "490859145",
            "telephone_number": "269-408-1644",
            "fax_number": "269-428-0019"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES SPORTS MEDICINE AND CONCUSSION CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-03-29",
        "last_updated": "2016-03-29",
        "status": "A",
        "authorized_official_last_name": "TRIGGER",
        "authorized_official_first_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "269-408-1644",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alison Graves
• Great Lakes Eye Care PC (Great Lakes Eye Care)
• Great Lakes Family Dental Group-St. Joseph
• Great Lakes Gastroenterology PLLC
• Great Lakes Heart & Vascular Institute, P.C.
• Great Lakes Surgery Center LLC
• Mark H Greenberg, MD
• Adrienne Greene, DPT
• Edward Glendon Greene, MPH, PT
• Samuel Z Gregor, CRNA

• Specialist in Saint Joseph, MI
• Providers in Saint Joseph, MI by specialty
• Specialist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2016; 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.