NPIMap

Organization Active NPI

Boyne Country Urgent Care P.C.

Doing business as Up North Medical Centers

  • Dermatopathology Physician
  • Gaylord, MI
National Provider Identifier
1972556702
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatopathology PhysicianTaxonomy code 207ND0900X
Legal business name
BOYNE COUNTRY URGENT CARE P.C.
Doing business as
Up North Medical Centers
Practice address
1951 S Otsego Ave
Gaylord, MI 49735-8489
Phone
(989) 732-3284
Fax
(989) 732-6395
NPI assigned
May 19, 2006
Last updated
Aug 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

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

Authorized official

Name
Destiney Green
Title
Manager
Phone
(989) 732-3284

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatopathology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207ND0900X Primary
Internal Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207R00000X
Medical Specialty Clinic/Center 261QM2500X

Addresses

Primary practice location

1951 S Otsego Ave
Gaylord, MI 49735-8489

Mailing address

1951 S Otsego Ave
Gaylord, MI 49735-8489
Phone (989) 732-3284

Other identifiers 1

IdentifierTypeStateIssuer
080B410910OtherMIBLUE CROSS BLUE SHIELD GR

Other names 1

  • Up North Medical Centers Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050523001240 MI Part B Supplier - Clinic/Group Practice 3173565850 Receives reassigned benefits from 7 practitioners
Practice locations: Gaylord, MI

National Provider Directory

National Provider Directory

Locations

1951 S Otsego Ave
Gaylord, MI 49735
Phone (989) 732-3284

1937 Harbor Petoskey Rd
#119
Petoskey, MI 49770
Phone (231) 348-9200

1937 M 119
Petoskey, MI 49770
Phone (231) 348-9200

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1147996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724630400000",
    "number": "1972556702",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1951 S OTSEGO AVE",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497358489",
            "telephone_number": "989-732-3284",
            "fax_number": "989-732-6395"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1951 S OTSEGO AVE",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497358489",
            "telephone_number": "989-732-3284",
            "fax_number": "989-732-6395"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOYNE COUNTRY URGENT CARE P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-19",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "DESTINEY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "989-732-3284"
    },
    "taxonomies": [
        {
            "code": "207ND0900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Dermatopathology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD GR",
            "identifier": "080B410910",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Up North Medical Centers",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gaylord, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.