Associates in Dermatology of Traverse City PC

Primary specialty

Dermatopathology PhysicianTaxonomy code 207ND0900X

License

JG058054 Issued in MI

Legal business name

ASSOCIATES IN DERMATOLOGY OF TRAVERSE CITY PC

Doing business as

Associates in Dermatology of Traverse City

Practice address

3643 W Front St
Traverse City, MI 49684-7759

Phone

(231) 935-0625

Fax

(231) 935-0626

NPI assigned

Jun 3, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Joan Michelle Griner, MD

Title

President

Phone

(231) 935-0625

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ASSOCIATES IN DERMATOLOGY OF TRAVERSE CITY Doing business as

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://traversedermatology.mmi.prod.fhir.ema-api.com/fhir/r4/

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Taylor Adlam, MD

  • Dermatology Physician
  • Dearborn, MI
  • NPI 1003473851
  Medicare reassignment Care Compare group NPD
• Raymond J Dean, MD

  • Procedural Dermatology Physician
  • Traverse City, MI
  • NPI 1023033255
  Medicare reassignment Care Compare group NPD
• Joan M Griner Licht, MD

  • Procedural Dermatology Physician
  • Traverse City, MI
  • NPI 1710902945
  Medicare reassignment Care Compare group NPD
• Jeffrey John Kelly, D.O.

  • Dermatology Physician
  • Traverse City, MI
  • NPI 1770565384
  Medicare reassignment Care Compare group NPD
• Melissa K. Sergent, PA

  • Physician Assistant
  • Troy, MI
  • NPI 1912350356
  Medicare reassignment Care Compare group
• Stacy N Slade, PA

  • Physician Assistant
  • Traverse City, MI
  • NPI 1265459267
  Medicare reassignment Care Compare group
• Michael Mark Nelson, M.D.

  • Dermatology Physician
  • Gig Harbor, WA
  • NPI 1093765034
  NPD (past)

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

{
    "created_epoch": "1149292800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193270400000",
    "number": "1861430779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3643 W FRONT ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847760",
            "telephone_number": "231-935-0625",
            "fax_number": "231-935-0626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3643 W FRONT ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496847759",
            "telephone_number": "231-935-0625",
            "fax_number": "231-935-0626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ASSOCIATES IN DERMATOLOGY OF TRAVERSE CITY PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-03",
        "last_updated": "2007-10-25",
        "status": "A",
        "authorized_official_last_name": "GRINER",
        "authorized_official_first_name": "JOAN",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "231-935-0625",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": "MI",
            "license": "JG058054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "DF3512",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ASSOCIATES IN DERMATOLOGY OF TRAVERSE CITY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Maureen E Ascione, ACNP
• Asclepius Borealis, PLC
• Juno Ashera
• Cheryl Lynn Askwith, LBSW
• Mary Ann Asmus, LMSW ACSW
• Stephanie Michelle Aten, PT
• Madison Atkinson, PA-C
• Atlas to Healing LLC
• Attitude Adjustments
• Attuned TC PLLC

• Dermatopathology Physician in Traverse City, MI
• Providers in Traverse City, MI by specialty
• Dermatopathology Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; 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.