NPIMap

Organization Active NPI

Grand Traverse Radiologists PC

  • Diagnostic Radiology Physician
  • Traverse City, MI
National Provider Identifier
1760404891
Registry record updated Apr 29, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
Legal business name
GRAND TRAVERSE RADIOLOGISTS PC
Practice address
1105 Sixth St
Traverse City, MI 49684-2345
Phone
(231) 935-0497
NPI assigned
Jul 25, 2006
Last updated
Apr 29, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2020

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

Authorized official

Name
Dr. Michelle M Lung, MDNPI 1275557456
Title
President
Phone
(231) 935-0497

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X Primary

Addresses

Primary practice location

1105 Sixth St
Traverse City, MI 49684-2345

Mailing address

PO Box 30516
Dept. 9516
Lansing, MI 48909-8016
Phone (800) 475-6112

Other identifiers 15

IdentifierTypeStateIssuer
008081OtherMIMIDWEST HEALTH PLAN
104756OtherMIPREFERRED CHOICES
53556AOtherMIHEALTH ALLIANCE PLAN
XX00308OtherMIHEALTHPLUS OF MI
27837OtherMICOMMUNITY CHOICE MI
4055OtherMIPRIORITY HEALTH
0B87605OtherMIBLUE CROSS BLUE SHIELD
134232100OtherMIUS DEPT. OF LABOR
280047OtherMIFEDERAL BLACK LUNG
N16010OtherMINORTHMED HMO
10399OtherMIM-CARE
104756OtherMICARE CHOICES
12088500MedicaidWI
803002OtherMICOMMUNITY CARE PLAN
CA3471OtherMIRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050124000780 MI Part B Supplier - Clinic/Group Practice 6002866407 Receives reassigned benefits from 35 practitioners
O20241127003678 IL Part B Supplier - Clinic/Group Practice 6002866407 Receives reassigned benefits from 1 practitioner
Practice locations: Hinsdale, IL

National Provider Directory

National Provider Directory

Locations

8881 M 119
Ste A
Harbor Springs, MI 49740
Phone (231) 347-5400

1345 E Parkdale Ave
Fl 2
Manistee, MI 49660
Phone (231) 398-1735

25500 Meadowbrook Rd
#115
Novi, MI 48375

1619 Anderson Rd
Ste A
Petoskey, MI 49770
Phone (231) 417-6000

1100 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

4100 Park Forest Dr
Ste 203
Traverse City, MI 49684
Phone (231) 392-7100

14477 Caberfae Hwy
Wellston, MI 49689
Phone (231) 655-0095

Practitioners & affiliated clinicians

Practitioners 38

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.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1153785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588118400000",
    "number": "1760404891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 30516",
            "address_2": "DEPT. 9516",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489098016",
            "telephone_number": "800-475-6112",
            "fax_number": "423-826-1286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842345",
            "telephone_number": "231-935-0497"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND TRAVERSE RADIOLOGISTS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-25",
        "last_updated": "2020-04-29",
        "certification_date": "2020-04-29",
        "status": "A",
        "authorized_official_last_name": "LUNG",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-935-0497",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MIDWEST HEALTH PLAN",
            "identifier": "008081",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CHOICES",
            "identifier": "104756",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE PLAN",
            "identifier": "53556A",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPLUS OF MI",
            "identifier": "XX00308",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY CHOICE MI",
            "identifier": "27837",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY HEALTH",
            "identifier": "4055",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0B87605",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "US DEPT. OF LABOR",
            "identifier": "134232100",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL BLACK LUNG",
            "identifier": "280047",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTHMED HMO",
            "identifier": "N16010",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "M-CARE",
            "identifier": "10399",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CARE CHOICES",
            "identifier": "104756",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12088500",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMUNITY CARE PLAN",
            "identifier": "803002",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA3471",
            "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 29, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.