NPIMap

Organization Active NPI

Traverse Area Pediatric and Adolescent Clinic PLC

  • Pediatrics Physician
  • Traverse City, MI
National Provider Identifier
1821380031
Registry record updated Apr 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
2522728 Issued in MI
Legal business name
TRAVERSE AREA PEDIATRIC AND ADOLESCENT CLINIC PLC
Practice address
4020 W Royal Dr
Traverse City, MI 49684-8965
Phone
(231) 421-8099
Fax
(231) 421-8599
NPI assigned
May 5, 2011
Last updated
Apr 16, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2013

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

Authorized official

Name
Dr. Karla Marie Smith, M.D.NPI 1710088414
Title
Managing Partner
Phone
(231) 421-8099

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 2522728 MI Primary

Addresses

Primary practice location

4020 W Royal Dr
Traverse City, MI 49684-8965

Mailing address

4020 W Royal Dr
Traverse City, MI 49684-8965
Phone (231) 421-8099

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
23D2030172Traverse Area Pediatric & Adolescent Clinic PLC4020 W Royal Drive, Traverse City, MI 49684Certificate of waiverSep 21, 2027

National Provider Directory

National Provider Directory

Locations

4020 W Royal Dr
Traverse City, MI 49684
Phone (231) 421-8099

Practitioners & affiliated clinicians

Practitioners 4

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": "1304553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1366070400000",
    "number": "1821380031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 W ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496848965",
            "telephone_number": "231-421-8099",
            "fax_number": "231-421-8599"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4020 W ROYAL DR",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496848965",
            "telephone_number": "231-421-8099",
            "fax_number": "231-421-8599"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRAVERSE AREA PEDIATRIC AND ADOLESCENT CLINIC PLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-05",
        "last_updated": "2013-04-16",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KARLA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "231-421-8099",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MI",
            "license": "2522728",
            "primary": true
        }
    ],
    "identifiers": [],
    "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 16, 2013; 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.