Individual provider Active NPI

Karri Elizabeth Vaughan, PA-C

  • Physician Assistant
  • Traverse City, MI
National Provider Identifier
1942295274
Registry record updated Mar 7, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601004084 Issued in MI
Practice address
4624 N Spider Lake Rd
Traverse City, MI 49696-8440
Phone
(231) 947-0673
NPI assigned
Sep 13, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601004084 MI Primary

Addresses

Primary practice location

4624 N Spider Lake Rd
Traverse City, MI 49696-8440

Mailing address

4373 Silver Valley LN
Traverse City, MI 49684-8796
Phone (231) 947-0673

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040414000698 MI Practitioner - Physician Assistant 3870587546 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
True North Medical PCGroup PAC ID 7315487790, 13 clinicians

Practice addresses (Care Compare)

4290 US
Suite 31
Traverse City, MI 49686-3761
Phone (231) 252-1810

630 W 14TH St
Traverse City, MI 49684-4050
Phone (231) 252-1810

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
5601004084MIMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Center CurrentSince Jul 1, 2008 Accepting new patients
Munson Medical Center CurrentSince Oct 12, 2016 Accepting new patients
Traverse Observation Physician Services PC Past Accepting new patients

Locations

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

400 Hobart St
Cadillac, MI 49601
Phone (231) 876-7200

1400 Medical Campus Dr
Traverse City, MI 49684
Phone (231) 935-8000

550 Munson Ave
Traverse City, MI 49686
Phone (231) 935-6600

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

Interoperability endpoints

  • Direct secure messaging: kvaughan@direct.mhc.net

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1126569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741305600000",
    "number": "1942295274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4373 SILVER VALLEY LN",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496848796",
            "telephone_number": "231-947-0673"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4624 N SPIDER LAKE RD",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496968440",
            "telephone_number": "231-947-0673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAUGHAN",
        "first_name": "KARRI",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-13",
        "last_updated": "2025-03-07",
        "certification_date": "2025-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601004084",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.