CRYSTAL LAKE CLINIC, PC (NPI# 1679844849) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679844849 |
| Entity Type | Organization |
| Organization Name | CRYSTAL LAKE CLINIC, PC |
| Practice Address |
5191 Rosewood Dr Traverse City MI 49685 |
| Mailing Address |
6227 Frankfort Hwy Benzonia MI 49616-8632 |
| Practice Telephone | 2318829661 |
| Mailing Telephone | 2318829661 |
| Enumeration Date | 2012-01-20 |
| Last Update Date | 2017-05-02 |
| Authorized Official Name | RICHARD C NIELSEN (PRESIDENT) |
| Authorized Official Telephone | 2318829661 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306190475 | Crystal Lake Clinic, PC | Family Medicine | 115 E 7th St, Manton, MI 49663-9429 | 2012-10-29 |
| Street Address |
5191 ROSEWOOD DR |
| City | TRAVERSE CITY |
| State | MI |
| Zip Code | 49685 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275771370 | Danielle Emily Koch | Nurse Practitioner | 5191 Rosewood Dr, Traverse City, MI 49685-9137 | 2009-01-27 |
| 1053812339 | Sarah Brokaw | Physical Therapist | 5191 Rosewood Dr, Traverse City, MI 49684 | 2018-02-22 |
| 1295154656 | Mark Langlois Jr. | Family Medicine | 5191 Rosewood Dr, Traverse City, MI 49685 | 2014-04-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508379496 | Alexandra Hull | Physical Therapist | 4177 Village Park Dr., Suite B, Traverse City, MI 49685 | 2017-11-14 |
| 1215452164 | Holli Home Health Care, LLC | Home Health | 2062 North Us-31 South, Suite A, Traverse City, MI 49685 | 2017-08-11 |
| 1013307867 | Culver Senior Living, Inc. | Foster Care Agency | 1745 N West Silver Lake Rd, Traverse City, MI 49685 | 2015-02-02 |
| 1487103610 | Laura Christine Field | Social Worker | 6325 Cherry Blossom Dr, Traverse City, MI 49685-5000 | 2016-09-29 |
| 1730132879 | Franklin Pharmacy Inc | Durable Medical Equipment & Medical Supplies | 404 W Commerce Dr, Suite B, Traverse City, MI 49685-5854 | 2006-05-18 |
| 1588281695 | Carly Overmire | Behavior Technician | 3000 Arborvitae Dr Apt 11, Traverse City, MI 49685-6708 | 2020-07-06 |
| 1134576853 | Paula Mclane | Registered Nurse | 2400 W Crown Dr Unit 1, Traverse City, MI 49685-6715 | 2016-05-23 |
| 1376927756 | Crystal Lake Clinic P.C. | Family Medicine | 4025 Chums Village Dr, Traverse City, MI 49685-6992 | 2015-07-15 |
| 1730500562 | Debra Swoverland | Physician Assistant | 4025 Chums Village Dr, Traverse City, MI 49685-6992 | 2013-12-20 |
| 1346338324 | Michael F Carroll | Family Medicine | 4025 Chums Village Dr, Traverse City, MI 49685-6992 | 2006-10-11 |
| Find all providers in zip 49685 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780177410 | Asclepius Borealis, Plc | Family Medicine | 42 N W Silver Lake Rd, Traverse City, MI 49685-8536 | 2018-06-07 |
| 1700260015 | Robert Jason | Family Medicine | 2728 Old Farm Ln, Traverse City, MI 49685-9066 | 2015-07-16 |
| 1033403779 | Donald James Aiken | Family Medicine | 16544 Wrightwood Terrace Dr, Traverse City, MI 49686-8342 | 2011-05-28 |
| 1447436480 | Carolyn C Moats, M.d. Plc | Family Medicine | 207 Circle Dr, Traverse City, MI 49684-2347 | 2008-01-19 |
| 1891994026 | April Elizabeth Kurkowski | Family Medicine | 10850 E Traverse Hwy Ste 4400, Traverse City, MI 49684-1320 | 2007-07-17 |
| 1104963115 | Debra Kay Graetz | Family Medicine | 647 E Eighth St, Traverse City, MI 49686-2682 | 2007-01-31 |
| 1184799199 | Jay Albert Klein | Family Medicine | 2950 Lafranier, Traverse City, MI 49686-4918 | 2006-11-22 |
| 1720157688 | Mark A Priest | Family Medicine | 945 E 8th St Ste B, Traverse City, MI 49686-2895 | 2006-11-07 |
| 1972680411 | Lynn Lapointe Swan | Family Medicine | 3147 Logan Valley Rd, Traverse City, MI 49684-4772 | 2006-11-01 |
| 1073608568 | Gary Stephen Ruoff | Family Medicine | 201 South Garfield Ave, Traverse City, MI 49686 | 2006-10-03 |
| Find all providers in TRAVERSE CITY | ||||
| City | TRAVERSE CITY |
| Zip Code | 49685 |
Please comment or provide details below to improve the information on CRYSTAL LAKE CLINIC, PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.