NPIMap

Organization Active NPI

Grand Traverse Children's Clinic

  • Pediatrics Physician
  • Traverse City, MI
National Provider Identifier
1750398871
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
GRAND TRAVERSE CHILDREN'S CLINIC
Doing business as
Grand Traverse Children's Clinic
Practice address
3537 W Front St Ste G
Traverse City, MI 49684-7943
Phone
(231) 935-8827
NPI assigned
Aug 2, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mrs. Leeann B Sprunk, RN
Title
Office Manager
Phone
(231) 935-8822

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X MI Primary

Addresses

Primary practice location

3537 W Front St Ste G
Traverse City, MI 49684-7943

Mailing address

3537 W Front St Ste G
Traverse City, MI 49684-7943
Phone (231) 935-8827

Other names 1

  • GRAND TRAVERSE CHILDREN'S CLINIC Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D0381385Grand Traverse Children's Clinic3537 West Front St Suite G, Traverse City, MI 49684Provider-performed microscopyAug 30, 2027

National Provider Directory

National Provider Directory

Locations

3537 W Front St
Ste G
Traverse City, MI 49684
Phone (231) 935-8822

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1750398871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3537 W FRONT ST STE G",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847943",
            "telephone_number": "231-935-8827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3537 W FRONT ST STE G",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847943",
            "telephone_number": "231-935-8827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND TRAVERSE CHILDREN'S CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-02",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "SPRUNK",
        "authorized_official_first_name": "LEEANN",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "231-935-8822",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GRAND TRAVERSE CHILDREN'S CLINIC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.