NPIMap

Individual provider Active NPI

Kristin S Maschke, M.D.

  • General Practice Physician
  • Lewiston, MI
National Provider Identifier
1992778807
Registry record updated May 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
4301068537 Issued in MI
Practice address
3040 Bourn St
Lewiston, MI 49756-8134
Phone
(989) 786-4877
Fax
(989) 786-2187
NPI assigned
Feb 10, 2006
Last updated
May 21, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 21, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X 4301068537 MI Primary

Addresses

Primary practice location

3040 Bourn St
Lewiston, MI 49756-8134

Mailing address

829 N Center Ave
Suite 298
Gaylord, MI 49735-1595
Phone (989) 731-7708

Other practice location 1

829 N Center Ave Ste 210
Gaylord, MI 49735-1599
Phone (989) 731-7860

Other identifiers 2

IdentifierTypeStateIssuer
0F96004OtherMIGROUP MEDICARE ID NUMBER
4503518MedicaidMI

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
I20080711000598 MI Practitioner - Family Practice 7810069564 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Michigan State University College of Human Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

829 N Ctr Ave
210 MHC Omh Med. Group Family Practice
Gaylord, MI 49735-1599
Phone (989) 731-7860

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Healthcare Otsego Memorial Hospital General Practice Current Accepting new patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Munson Healthcare Otsego Memorial Hospital Current Accepting new patients
Munson Healthcare Otsego Memorial Hospital CurrentSince Jul 1, 2008 Accepting new patients
Munson Healthcare Otsego Memorial Hospital General Practice CurrentSince Jul 1, 2008 Accepting new patients
Petoskey Surgeons, P.C. Past Accepting new patients

Locations

825 N Center Ave
Gaylord, MI 49735
Phone (989) 731-2100

829 N Center Ave
Gaylord, MI 49735
Phone (989) 731-2100

829 N Center Ave
Ste 210
Gaylord, MI 49735
Phone (989) 731-7860

829 N Center Ave
Ste 298
Gaylord, MI 49735
Phone (989) 731-7707

3040 Bourn St
Lewiston, MI 49756
Phone (989) 731-7777

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

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Munson Healthcare Omh Medical Group Lewiston RHCLewiston, MI, CCN 238620 Rural health clinic W-2 Managing Employee Jul 1, 2006

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716249600000",
    "number": "1992778807",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "829 N CENTER AVE",
            "address_2": "SUITE 298",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351595",
            "telephone_number": "989-731-7708",
            "fax_number": "989-731-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3040 BOURN ST",
            "city": "LEWISTON",
            "state": "MI",
            "postal_code": "497568134",
            "telephone_number": "989-786-4877",
            "fax_number": "989-786-2187"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "829 N Center Ave Ste 210",
            "address_purpose": "LOCATION",
            "city": "Gaylord",
            "state": "MI",
            "postal_code": "497351599",
            "country_code": "US",
            "telephone_number": "989-731-7860",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MASCHKE",
        "first_name": "KRISTIN",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-10",
        "last_updated": "2024-05-21",
        "certification_date": "2024-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "MI",
            "license": "4301068537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP MEDICARE ID NUMBER",
            "identifier": "0F96004",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4503518",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewiston, MI

Sources for this page

Verify at the official NPI Registry.