Individual provider Active NPI

Scott B Davidson, MD

  • Surgery Physician
  • Traverse City, MI
National Provider Identifier
1811977424
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
4301056087 Issued in MI
Practice address
1105 Sixth St
Traverse City, MI 49684-2345
Phone
(231) 935-7514
Fax
(231) 392-0039
NPI assigned
Jan 19, 2006
Last updated
Sep 27, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 4301056087 MI Primary

Addresses

Primary practice location

1105 Sixth St
Traverse City, MI 49684-2345

Mailing address

601 John St
Suite M452
Kalamazoo, MI 49007-5341
Phone (269) 341-6022

Other practice location 1

1221 Sixth St Ste 300
Traverse City, MI 49684-2360
Phone (231) 935-2400

Other practice location 2

601 John St
Suite M452
Kalamazoo, MI 49007-5341
Phone (269) 341-6022

Other practice location 3

4100 Park Forest Dr
Traverse City, MI 49684-7331
Phone (231) 392-8900

Other identifiers 2

IdentifierTypeStateIssuer
CA2184OtherMIRAILROAD MEDICARE
4575043MedicaidMI

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address direct@direct.bronsonhg.org Direct Bronson Healthcare Group

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040225001010 MI Practitioner - General Surgery 8022920511 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Wayne State University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Munson Medical CenterGroup PAC ID 3072426287, 377 clinicians

Practice addresses (Care Compare)

1105 6TH St
Traverse City, MI 49684-2345
Phone (231) 935-7514

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.43 of 100Reported as group
Quality
75.38
Promoting interoperability
100
Improvement activities
40
Cost
79.38

Merit-based Incentive Payment System (MIPS)

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

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Center Current Accepting new patients
Munson Medical Center CurrentSince Apr 1, 2022 Accepting new patients
Acute Care Surgery Medical Group, Inc. Surgery CurrentSince Oct 9, 2019 Accepting new patients
Munson Medical Center CurrentSince Apr 1, 2022 Accepting new patients
Munson Medical Center Past Accepting new patients

Locations

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

416 Connable Ave
Petoskey, MI 49770
Phone (231) 487-4000

50 N Perry St
#2
Pontiac, MI 48342
Phone (248) 338-5865

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

1221 Sixth St
Ste 100
Traverse City, MI 49684
Phone (231) 392-8400

1221 Sixth St
Ste 300
Traverse City, MI 49684
Phone (231) 392-0640

1400 Medical Campus Dr
Traverse City, MI 49684
Phone (231) 935-8000

4100 Park Forest Dr
Traverse City, MI 49684
Phone (231) 392-8900

Ownership & related parties

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Bronson Lakeview HospitalPaw Paw, MI, CCN 231332 Hospital Corporate Director Sep 22, 2016
Bronson South Haven HospitalSouth Haven, MI, CCN 23U085 Hospital Corporate Director Jan 1, 2017
Bronson Lakeview HospitalPaw Paw, MI, CCN 23Z332 Hospital Corporate Director Sep 22, 2016
Bronson Lakeview Family Care-Paw PawPaw Paw, MI, CCN 238601 Rural health clinic Corporate Director Sep 22, 2016

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

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": "1137628800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1811977424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 JOHN ST",
            "address_2": "SUITE M452",
            "city": "KALAMAZOO",
            "state": "MI",
            "postal_code": "490075341",
            "telephone_number": "269-341-6022",
            "fax_number": "269-341-8244"
        },
        {
            "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": "231-935-7514",
            "fax_number": "231-392-0039"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1221 Sixth St Ste 300",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496842360",
            "country_code": "US",
            "telephone_number": "231-935-2400",
            "fax_number": "231-392-2424",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "601 John St",
            "address_2": "Suite M452",
            "address_purpose": "LOCATION",
            "city": "Kalamazoo",
            "state": "MI",
            "postal_code": "490075341",
            "country_code": "US",
            "telephone_number": "269-341-6022",
            "fax_number": "269-341-8244",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4100 Park Forest Dr",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496847331",
            "country_code": "US",
            "telephone_number": "231-392-8900",
            "fax_number": "231-392-8973",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "SCOTT",
        "middle_name": "B",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-19",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "4301056087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA2184",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4575043",
            "state": "MI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "direct@direct.bronsonhg.org",
            "affiliation": "Y",
            "endpointDescription": "Bronson Healthcare Group Direct address",
            "affiliationName": "Bronson Healthcare Group",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Continuity of Care Document",
            "address_1": "601 John St",
            "city": "Kalamazoo",
            "state": "MI",
            "country_code": "US",
            "postal_code": "490075341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.