NPIMap

Individual provider Active NPI

Kerry L Kole, DO

  • Surgery Physician
  • Traverse City, MI
National Provider Identifier
1912996166
Registry record updated Oct 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
5101012055 Issued in MI
Practice address
1105 Sixth St
Traverse City, MI 49684
Phone
(231) 935-7514
NPI assigned
Oct 20, 2005
Last updated
Oct 22, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2020

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 5101012055 MI Primary

Addresses

Primary practice location

1105 Sixth St
Traverse City, MI 49684

Mailing address

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

Other practice location 1

27483 Dequindre Rd
Suite 204
Madison Heights, MI 48071-3491
Phone (248) 684-6656

Other practice location 2

1010 W North Down River Rd
Grayling, MI 49738-2060
Phone (231) 935-7514

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kkole86377@direct.beaumont.edu

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
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
I20040301000361 MI Practitioner - General SurgeryPractitioner - Critical Care (Intensivists) 1850288333 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Critical Care (Intensivists)
Education
Michigan State University College of Osteopathic Medicine, 1993
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

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Removal of tissue1-10

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Center Current Accepting new patients
Munson Healthcare Grayling CurrentSince Aug 19, 2019 Accepting new patients
Munson Medical Center CurrentSince Aug 19, 2019 Accepting new patients
Munson Healthcare Grayling Surgery CurrentSince Aug 19, 2019 Accepting new patients
Critical Care Surgeons PLLC CurrentSince Dec 28, 2013 Accepting new patients
Munson Healthcare Grayling Current Accepting new patients
Munson Medical Center CurrentSince Aug 19, 2019 Accepting new patients
Mso Physicians Surgery Past Accepting new patients
Munson Healthcare Grayling Past Accepting new patients
Munson Medical Center Past Accepting new patients
Munson Medical Center Past Accepting new patients

Locations

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

3781 Momentum Pl
Chicago, IL 60689

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

1010 W North Down River Rd
Grayling, MI 49738
Phone (989) 348-0800

1250 E Michigan Ave
Grayling, MI 49738
Phone (989) 348-0550

16001 W 9 Mile Rd
Southfield, MI 48075
Phone (248) 424-3000

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

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

Interoperability endpoints

  • Direct secure messaging: kkole2@direct.mhc.net
  • Direct secure messaging: kkole86377@direct.beaumont.edu

Organizations & group practices 11

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 3

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": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603324800000",
    "number": "1912996166",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": "49684",
            "telephone_number": "231-935-7514"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "27483 Dequindre Rd",
            "address_2": "Suite 204",
            "address_purpose": "LOCATION",
            "city": "Madison Heights",
            "state": "MI",
            "postal_code": "480713491",
            "country_code": "US",
            "telephone_number": "248-684-6656",
            "fax_number": "248-967-7330",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1010 W North Down River Rd",
            "address_purpose": "LOCATION",
            "city": "Grayling",
            "state": "MI",
            "postal_code": "497382060",
            "country_code": "US",
            "telephone_number": "231-935-7514",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KOLE",
        "first_name": "KERRY",
        "middle_name": "L",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2020-10-22",
        "certification_date": "2020-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "MI",
            "license": "5101012055",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kkole86377@direct.beaumont.edu",
            "affiliation": "N",
            "address_1": "27483 Dequindre Rd",
            "address_2": "Suite 204",
            "city": "Madison Heights",
            "state": "MI",
            "country_code": "US",
            "postal_code": "480713491",
            "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.