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CRYSTAL LAKE CLINIC P.C.
NPI 1417902057
Family Medicine in Interlochen, MI

Active since May 23, 2006
1975 STIRLING DR, INTERLOCHEN, MI 49643(231) 275-7965 Get Directions Write a Review

NPPES record last updated: February 14, 2011. Verified against the NPPES registry weekly; last sync: August 16, 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 1417902057) is a healthcare organization registered as a family medicine in Interlochen, Michigan and active in the NPI registry since May 2006. The organization lists Richard C Nielsen, President, as its authorized official.

NPPES Registry Identity

NPI1417902057
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameCRYSTAL LAKE CLINIC P.C.
Location Address1975 STIRLING DRInterlochen, MI 49643-9264
Mailing Address6227 Frankfort HwyBenzonia, MI 49616-9654 · (231) 882-9661 · Fax (231) 882-9616
Phone(231) 275-7965
Organization SubpartNo
Authorized OfficialRichard C NielsenPresident · (231) 882-9661
Enumeration DateMay 23, 2006
Last NPPES UpdateFebruary 14, 2011
✔ NPI 1417902057 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ 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.
Also ListedPediatricsTaxonomy 208000000X
1975 STIRLING DR, Interlochen, MI 49643
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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

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Buckeye Health Plan, Ambetter from Meridian, Ambetter Health and more.Insurance ›

Other Providers at the Same Location NPPES 6

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

LINDA JANE WADE
Physical Therapist
1975 STIRLING DR
INTERLOCHEN, MI 49643
Grand Traverse County (231) 275-0166
ASHLEY MARIE GOSS FNP-C
Nurse Practitioner (Family)
1975 STIRLING DR
INTERLOCHEN, MI 49643
Grand Traverse County (231) 275-7965
ROBERTA L HERBST PA-C
Physician Assistant
1975 STIRLING DR
INTERLOCHEN, MI 49643
Grand Traverse County (231) 275-7965
MARK A. BARBER D.O.
Family Medicine
1975 STIRLING DR
INTERLOCHEN, MI 49643
Grand Traverse County (231) 275-7965
MRS. NANCY LEE DORMAN FNP-C
Nurse Practitioner (Family)
1975 STIRLING DR
INTERLOCHEN, MI 49643
Grand Traverse County (231) 275-7965
DAWN EDGLEY
Physical Therapist
1975 STIRLING DR
INTERLOCHEN, MI 49643
Grand Traverse County (231) 275-0166

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 1417902057. It was assigned to this organization in the NPPES registry on May 23, 2006.

Where is Crystal Lake Clinic P.C. located?

Crystal Lake Clinic P.C. is located at 1975 Stirling Dr, Interlochen, MI 49643. The listed phone number is (231) 275-7965.

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 February 14, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years 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.