NPIMap

Organization Active NPI

Regents of the University of Michigan

  • Pediatric Rheumatology Physician
  • Traverse City, MI
National Provider Identifier
1992081640
Registry record updated Apr 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Rheumatology PhysicianTaxonomy code 2080P0216X
Legal business name
REGENTS OF THE UNIVERSITY OF MICHIGAN
Practice address
1200 Sixth St
Suite 100
Traverse City, MI 49684-2369
Phone
(231) 935-5000
NPI assigned
Oct 26, 2011
Organization subpart
Yes
Parent organization
REGENTS OF THE UNIVERSITY OF MICHIGANAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 30, 2021

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

Authorized official

Name
David Christopher Miller, MD
Title
President
Phone
(734) 936-3568

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X MI
Pediatric Rheumatology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0216X MI Primary

Addresses

Primary practice location

1200 Sixth St
Suite 100
Traverse City, MI 49684-2369

Mailing address

3621 S State St
Provider Enrollment
Ann Arbor, MI 48108-1633
Phone (734) 647-5299

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031106000325 MI Part B Supplier - Clinic/Group Practice 3779496856 Receives reassigned benefits from 2,340 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Regents of Univ of Michigan157 organizations share this tax ID, including this one
Part of
Regents of Univ of Michigan

Organizations with this tax ID in the same state 12

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

1200 Sixth St
Ste 100
Traverse City, MI 49684
Phone (616) 267-1925

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1319587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619740800000",
    "number": "1992081640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "PROVIDER ENROLLMENT",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 SIXTH ST",
            "address_2": "SUITE 100",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842369",
            "telephone_number": "231-935-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENTS OF THE UNIVERSITY OF MICHIGAN",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "REGENTS OF THE UNIVERSITY OF MICHIGAN",
        "enumeration_date": "2011-10-26",
        "last_updated": "2021-04-30",
        "certification_date": "2021-04-13",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "CHRISTOPHER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "734-936-3568",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0216X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Rheumatology",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2021; 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.