CRYSTAL LAKE CLINIC P.C.
NPI 1376927756
Family Medicine in Traverse City, MI

Active since July 15, 2015
4025 CHUMS VILLAGE DR, TRAVERSE CITY, MI 49685(231) 715-3613 Get Directions Write a Review

NPPES record last updated: July 15, 2015. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Crystal Lake Clinic P.c. NPPES

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

CRYSTAL LAKE CLINIC P.C. (NPI 1376927756) is a healthcare organization registered as a family medicine in Traverse City, Michigan and active in the NPI registry since July 2015. The organization lists Richard C Nielsen, President, as its authorized official.

NPPES Registry Identity

NPI1376927756
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameCRYSTAL LAKE CLINIC P.C.
Location Address4025 CHUMS VILLAGE DRTraverse City, MI 49685-6992
Mailing Address6227 Frankfort HwyBenzonia, MI 49616-8632 · (231) 882-9661 · Fax (231) 882-9616
Organization SubpartNo
Authorized OfficialRichard C NielsenPresident · (231) 882-9661
Enumeration DateJuly 15, 2015
NPI 1376927756 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
Definition

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.

4025 CHUMS VILLAGE DR, Traverse City, MI 49685

Other Identifiers 1

Medicare PIN0N38430MI

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

Other Providers at the Same Location NPPES 3

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

Family Medicine
4025 CHUMS VILLAGE DR
TRAVERSE CITY, MI 49685
Physician Assistant
4025 CHUMS VILLAGE DR
TRAVERSE CITY, MI 49685
Family Medicine
4025 CHUMS VILLAGE DR
TRAVERSE CITY, MI 49685

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Crystal Lake Clinic P.C.'s NPI number?

The NPI number for Crystal Lake Clinic P.C. is 1376927756. It was assigned to this organization in the NPPES registry on July 15, 2015.

Where is Crystal Lake Clinic P.C. located?

Crystal Lake Clinic P.C. is located at 4025 Chums Village Dr, Traverse City, MI 49685. The listed phone number is (231) 715-3613.

What is Crystal Lake Clinic P.C.'s specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

What insurance does Crystal Lake Clinic P.C. accept?

Health plans from Ambetter Health, Ambetter from Buckeye Health Plan, Ambetter from Meridian, Blue Care Network of Michigan and Blue Cross Blue Shield of Michigan Mutual Insurance Company list Crystal Lake Clinic P.C. as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Crystal Lake Clinic P.C. was last updated on July 15, 2015. NPI Profile syncs with the weekly NPPES data releases published by CMS.