NPIMap

Individual provider Active NPI

Mitzi Colleen Amelon, D.O.

  • Family Medicine Physician
  • Gwinn, MI
National Provider Identifier
1831140409
Registry record updated Oct 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
5101010674 Issued in MI
Practice address
135 E M35
Gwinn, MI 49841-9160
Phone
(906) 346-9275
Fax
(906) 372-3230
NPI assigned
May 16, 2006
Last updated
Oct 29, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 29, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 5101010674 MI Primary

Addresses

Primary practice location

135 E M35
Gwinn, MI 49841-9160

Mailing address

301 Explorer St
Gwinn, MI 49841-2813
Phone (906) 481-8586

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL
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
I20230124000377 AL Practitioner - Family Practice 8325029663 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Osteopathic Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Upper Great Lakes Family Health CenterGroup PAC ID 1951432384, shared by 12 NPIs, 41 clinicians

Practice addresses (Care Compare)

135 E
Gwinn, MI 49841-9160
Phone (906) 346-9275

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2958ALMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Upper Great Lakes Family Health Center CurrentSince Oct 15, 2024 Accepting new patients
Pathology Laboratory Associates Current Accepting new patients
Upper Great Lakes Family Health Center CurrentSince Oct 15, 2024 Accepting new patients
Houston County Healthcare Authority Current Accepting new patients
Houston County Healthcare Authority Family Medicine CurrentSince Nov 28, 2022 Accepting new patients
Houston County Healthcare Authority Family Medicine Current Accepting new patients
Upper Great Lakes Family Health Center Family Medicine Current Accepting new patients
Medcore Associates, PLLC Current Accepting new patients
Upper Great Lakes Family Health Center Family Medicine Past Accepting new patients
State of Michigan Office of Financial Management PastSince Sep 24, 2023 Accepting new patients

Locations

415 Midland St
Ashford, AL 36312
Phone (334) 899-3363

1108 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-3635

135 E State Highway M35
Gwinn, MI 49841
Phone (906) 346-9275

301 Explorer St
Gwinn, MI 49841
Phone (906) 346-4924

500 Campus Dr
Hancock, MI 49930
Phone (906) 483-1000

Organizations & group practices 10

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 4

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": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730160000000",
    "number": "1831140409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 EXPLORER ST",
            "city": "GWINN",
            "state": "MI",
            "postal_code": "498412813",
            "telephone_number": "906-481-8586",
            "fax_number": "906-483-1394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "135 E M35",
            "city": "GWINN",
            "state": "MI",
            "postal_code": "498419160",
            "telephone_number": "906-346-9275",
            "fax_number": "906-372-3230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMELON",
        "first_name": "MITZI",
        "middle_name": "COLLEEN",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2024-10-29",
        "certification_date": "2024-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "5101010674",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gwinn, MI

Sources for this page

Verify at the official NPI Registry.