Gloria M Klaassen Witt, M.D.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301053535 Issued in MI

Practice address

493 N Derenzy Rd
Central Lake, MI 49622-9566

Phone

(231) 544-7001

Fax

(231) 600-7054

NPI assigned

Feb 14, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Yes, effective Jan 5, 2022 through Jan 5, 2028

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Secret Forest Country Doctor

  • Family Medicine Physician
  • Central Lake, MI
  • NPI 1447967153
  NPD Authorized official

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

{
    "created_epoch": "1392336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666915200000",
    "number": "1851715536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "493 N DERENZY RD",
            "city": "CENTRAL LAKE",
            "state": "MI",
            "postal_code": "496229566",
            "telephone_number": "231-544-7001",
            "fax_number": "231-600-7054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "493 N DERENZY RD",
            "city": "CENTRAL LAKE",
            "state": "MI",
            "postal_code": "496229566",
            "telephone_number": "231-544-7001",
            "fax_number": "231-600-7054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WITT",
        "first_name": "GLORIA",
        "middle_name": "M KLAASSEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-02-14",
        "last_updated": "2022-10-28",
        "certification_date": "2022-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301053535",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea Kline, CADC. CPRC
• Briana Marie Padgett, PSY S
• Shantel Mary Potter, NPI
• Secret Forest Country Doctor
• Whites Senior Assistance LLC (Acts of Love Home Companions)

• Family Medicine Physician in Central Lake, MI
• Providers in Central Lake, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.