MS. MARY KATHRYN DOUGLAS PAC
NPI 1114928637
Physician Assistant - Medical in Traverse City, MI

Q: What is Mary Douglas's NPI number?

The NPI number for Mary Douglas is 1114928637. It was assigned to this individual provider in the NPPES registry on August 9, 2005.

Q: What is Mary Douglas's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Medical, with taxonomy code 363AM0700X.

Q: When was this NPI record last updated?

The NPPES record for Mary Douglas was last updated on January 27, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since August 09, 2005PECOS EnrolledAccepts Medicare Assignment

3074 N US 31 S, TRAVERSE CITY, MI 49684(231) 929-1234 Get Directions Write a Review

NPPES record last updated: January 27, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 30, 2023, Jul 5, 2023, Oct 22, 2020 and 1 more (4 updates tracked since 2019).

On this page

About Ms. Mary Kathryn Douglas Pac NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MS. MARY KATHRYN DOUGLAS PAC (NPI 1114928637) is an individual medical provider in Traverse City, Michigan, licensed in Michigan (MD003850) and active in the NPI registry since August 2005. She is enrolled in Medicare PECOS, is affiliated with Munson Medical Center, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1114928637

Entity TypeIndividualFemale

Primary Taxonomy363AM0700X

Provider Legal NameMS. MARY KATHRYN DOUGLASCredential: PAC

Location Address3074 N US 31 STraverse City, MI 49684-4533

Mailing Address3074 N Us 31 STraverse City, MI 49684-4533 · (231) 929-1234 · Fax (231) 935-0984

Phone(231) 929-1234

Sole ProprietorNo

Medical School CMSOtherGraduated 2002

Enumeration DateAugust 9, 2005

Last NPPES UpdateJanuary 27, 20254 updates tracked since enumeration

NPPES CertifiedJanuary 27, 2025

✔ NPI 1114928637 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPhysician Assistant · MedicalPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363AM0700X

License✔ Licensed in MI · MD003850

3074 N US 31 S, Traverse City, MI 49684

Open in Google Maps ↗

Secondary Practice Locations 2

Location 1550 Munson AveTraverse City, MI 49686-3580 · Phone (231) 935-8686

Location 21105 Sixth StTraverse City, MI 49684-2345 · Phone (231) 935-5000

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Care Network of Michigan, Blue Cross Blue Shield of Michigan Mutual Insurance Company, McLaren Health Plan Community and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Ms. Mary Kathryn Douglas Pac is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5294833125

PECOS Enrollment IDI20140923002526

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 4

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213

This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.

101 services92 patients

New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more 99203

This service involves an initial office or outpatient visit for a new patient. The healthcare professional will spend 30-44 minutes understanding your health history, current issues, and discussing possible treatment plans. It's a comprehensive evaluation to start your healthcare journey.

94 services94 patients

Manual urinalysis test with examination using microscope, non-automated 81000

A manual urinalysis test involves studying a urine sample under a microscope. This non-automated method helps identify any abnormal substances present. It's a useful tool for detecting potential health concerns early. The process is simple and non-invasive.

21 services19 patients

X-ray of chest, 2 views 71046

A chest X-ray, 2 views, is a quick, painless test that creates pictures of the structures inside your chest, such as your heart, lungs, and blood vessels. Two different angles are used to get a comprehensive view. This helps in diagnosing conditions like pneumonia, heart problems, or lung cancer.

14 services14 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Munson Medical Center

Acute Care Hospitals · Traverse City, MI

5/5 CMS rating

OwnershipVoluntary non-profit - Other

CMS Certification Number230097

Location1105 Sixth StreetTraverse City, MI 49684 · Grand Traverse County

Emergency services Birthing friendly

Referred Medical Equipment & Supplies CMS DME claims

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553

DME-Other DME · category DE017N

1 supplier11 claims11 services$175.53 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MUNSON MEDICAL CENTER

Family Medicine