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NOVELLO SPECIALTY CLINIC PC
NPI 1629716964
Clinic/Center - Multi-Specialty in Traverse City, MI

Active since May 26, 2022CLIA 23D2269939 · Microscopy
4100 PARK FOREST DR STE 200, TRAVERSE CITY, MI 49684(231) 600-7466 Get Directions Write a Review

NPPES record last updated: April 9, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Apr 9, 2025, Feb 10, 2025, Aug 15, 2022 and 2 more (5 updates tracked since 2022).

About Novello Specialty Clinic Pc NPPES

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

NOVELLO SPECIALTY CLINIC PC (NPI 1629716964) is a healthcare organization registered as a multi-specialty in Traverse City, Michigan and active in the NPI registry since May 2022. The organization holds a CLIA Microscopy certificate valid through October 5, 2026 and lists Kristen Elliott, Director, Operations, as its authorized official.

NPPES Registry Identity

NPI1629716964
Entity TypeOrganization
Primary Taxonomy261QM1300X
Legal Business NameNOVELLO SPECIALTY CLINIC PC
Location Address4100 PARK FOREST DR STE 200Traverse City, MI 49684-7306
Mailing Address4290 Copper Ridge Dr Ste 110Traverse City, MI 49684-7208 · (231) 421-8505
Phone(231) 600-7466
Organization SubpartNo
Authorized OfficialKristen ElliottDirector, Operations · (231) 360-0183
Enumeration DateMay 26, 2022
Last NPPES UpdateApril 9, 20255 updates tracked since enumeration
NPPES CertifiedFebruary 10, 2025
✔ NPI 1629716964 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyClinic/Center · Multi-SpecialtyAmbulatory Health Care Facilities
Taxonomy Code261QM1300X
Also ListedInternal Medicine · RheumatologyTaxonomy 207RR0500X
Also ListedUrologyTaxonomy 208800000X
4100 PARK FOREST DR STE 200, Traverse City, MI 49684
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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 ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 23D2269939

Novello Specialty Clinic · Traverse City, MI
Active · expires Oct 5, 2026
CLIA Number23D2269939
Laboratory TypePhysician Office
Certificate Effective DateOctober 6, 2024
Certificate Expiration DateOctober 5, 2026
Laboratory DirectorMichael J. Harris
Laboratory Phone(231) 600-7466
Laboratory LocationNovello Specialty Clinic4100 Park Forest Drive Suite 200, Traverse City, MI 49684
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES 5

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

DR. SHANLEY MARIE O'BRIEN MD
Internal Medicine (Rheumatology)
4100 PARK FOREST DR STE 200
TRAVERSE CITY, MI 49684
Grand Traverse County (231) 600-7466
MICHAEL HARRIS MD
Urology
4100 PARK FOREST DR STE 200
TRAVERSE CITY, MI 49684
Grand Traverse County (231) 600-7466
MR. CORNELIUS ROBENS M.D.
Psychiatry & Neurology (Neurology)
4100 PARK FOREST DR STE 200
TRAVERSE CITY, MI 49684
Grand Traverse County (231) 600-7466
JENNA ROSE STODDARD FNP
Nurse Practitioner (Family)
4100 PARK FOREST DR STE 200
TRAVERSE CITY, MI 49684
Grand Traverse County (231) 600-7466
ALICIA HILL PA-C
Physician Assistant
4100 PARK FOREST DR STE 200
TRAVERSE CITY, MI 49684
Grand Traverse County (231) 600-7466

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 Novello Specialty Clinic PC's NPI number?

The NPI number for Novello Specialty Clinic PC is 1629716964. It was assigned to this organization in the NPPES registry on May 26, 2022.

Where is Novello Specialty Clinic PC located?

Novello Specialty Clinic PC is located at 4100 Park Forest Dr Ste 200, Traverse City, MI 49684. The listed phone number is (231) 600-7466.

What is Novello Specialty Clinic PC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Multi-Specialty, with taxonomy code 261QM1300X.

Does Novello Specialty Clinic PC hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 23D2269939) is associated with this NPI, valid through October 5, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Novello Specialty Clinic PC 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 Novello Specialty Clinic PC 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 Novello Specialty Clinic PC was last updated on April 9, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 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.