NPIMap

Individual provider Active NPI

Marc S Krakow, M.D.

  • Emergency Medical Services (Emergency Medicine) Physician
  • Kalkaska, MI
National Provider Identifier
1730185273
Registry record updated Nov 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X
License
4301059989 Issued in MI
Practice address
419 S Coral St
Kalkaska, MI 49646-2503
Phone
(231) 258-7506
Fax
(231) 258-7592
NPI assigned
Jun 21, 2005
Last updated
Nov 27, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 4301059989 MI Primary

Addresses

Primary practice location

419 S Coral St
Kalkaska, MI 49646-2503

Mailing address

1105 6TH St
Traverse City, MI 49684-2349
Phone (231) 947-0673

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address marckrakow@direct-address.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101206000436 MI Practitioner - Emergency Medicine 2769376227 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Chicago College of Medicine and Surgery, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kalkaska Memorial Health CenterGroup PAC ID 3577536002, 57 clinicians

Practice addresses (Care Compare)

419 S Coral St
Kalkaska, MI 49646-2503
Phone (231) 258-7500

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue438

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301059989MIMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Kalkaska Memorial Health Center CurrentSince Dec 1, 2024 Accepting new patients
Northwestern Michigan Emergency Physicians PC CurrentSince Aug 1, 2002 Accepting new patients
Kalkaska Memorial Health Center CurrentSince Dec 1, 2024 Accepting new patients
Lake Emergency Services Inc Past Accepting new patients
Lake Hospital System, Inc Past Accepting new patients
Indigo Services, PLC Emergency Medical Services Past Accepting new patients
Anesthesia Associates, PLL Past Accepting new patients

Locations

419 S Coral St
Kalkaska, MI 49646
Phone (231) 258-7500

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

Interoperability endpoints

  • Direct secure messaging: marckrakow@direct-address.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1119312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1732665600000",
    "number": "1730185273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 6TH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842349",
            "telephone_number": "231-947-0673",
            "fax_number": "801-740-2847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 S CORAL ST",
            "city": "KALKASKA",
            "state": "MI",
            "postal_code": "496462503",
            "telephone_number": "231-258-7506",
            "fax_number": "231-258-7592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRAKOW",
        "first_name": "MARC",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-21",
        "last_updated": "2024-11-27",
        "certification_date": "2024-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "MI",
            "license": "4301059989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "marckrakow@direct-address.org",
            "affiliation": "N",
            "address_1": "1105 6th St",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "496842349",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Kalkaska, MI

Sources for this page

Verify at the official NPI Registry.