PONTIAC TRAIL MEDICAL CENTER
NPI 1790901072
Family Medicine - Hospice and Palliative Medicine in Walled Lake, MI

NPI Status: Active since April 17, 2007

Contact Information

620 N PONTIAC TRL
WALLED LAKE, MI
ZIP 48390
Phone: (248) 624-4511
Fax: (248) 624-4408

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  • Organization
  • Family Medicine
  • Hospice and Palliative Medicine
  • Accepts Insurance
  • Medicare Supplier
  • Accepts Medicare Approved Payment
  • CLIA Number: 23D0691773
  • CLIA Cert. Type: Physician Office
  • CLIA Exp. Date: 02-15-2027

About PONTIAC TRAIL MEDICAL CENTER

This page provides the complete NPI Profile along with additional information for Pontiac Trail Medical Center, a provider established in Walled Lake, Michigan operating as a Family Medicine, focusing in hospice and palliative medicine . The healthcare provider is registered in the NPI registry with number 1790901072 assigned on April 2007. The practitioner's primary taxonomy code is 207QH0002X with license number 5101013058 (MI). The provider is registered as an organization and their NPI record was last updated 5 years ago. Pontiac Trail Medical Center operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The provider's is doing business as Pontiac Trail Medical Center. The authorized official of this NPI record is Mrs. Debbie Sue Witt-haggerty (Office Manager)

NPI
1790901072
Provider Legal Name
GARY HOLLANDER DO PLC
Other Organization Name
PONTIAC TRAIL MEDICAL CENTER
Other Name Type
Doing Business As (3)
Entity Type
Organization
Location Address
620 N PONTIAC TRL WALLED LAKE, MI 48390
Location Phone
(248) 624-4511
Location Fax
(248) 624-4408
Mailing Address
620 N PONTIAC TRL WALLED LAKE, MI 48390
Mailing Phone
(248) 624-4511
Mailing Fax
(248) 624-4408
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
04-17-2007
Last Update Date
08-22-2020
Code Navigator



Pontiac Trail Medical Center is a medicare supplier with PTAN 20554865 who accepts Medicare assignment for all durable medical equipment and supplies. The provider accepts the Medicare allowable as payment in full.The supplier carries the following product categories: Blood Glucose Monitors/Supplies (Non-Mail Order) or Canes and/or Crutches or Walkers or Orthoses: Off-The-Shelf or Ostomy Supplies or Urological Supplies or Nebulizer Equipment and/or Supplies or Surgical Dressings.

Location Map

Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Family Medicine Hospice and Palliative Medicine

Taxonomy Code
207QH0002X
Type
Allopathic & Osteopathic Physicians
License No.
5101013058
License State
MI
Taxonomy Description
A family medicine physician with special knowledge and skills to prevent and relieve the suffering experienced by patients with life-limiting illnesses. This specialist works with an interdisciplinary hospice or palliative care team to maximize quality of life while addressing physical, psychological, social and spiritual needs of both patient and family throughout the course of the disease, through the dying process, and beyond for the family. This specialist has expertise in the assessment of patients with advanced disease; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse venues; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care.

Secondary Taxonomies

The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.

No. Taxonomy Code Type Classification /
Specialization
License No. (State)

Group Taxonomy 193200000X MULTI-SPECIALTY GROUP

This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.

Insurance Plans Accepted

According to publicly available information the provider might be accepting the following health plans from these health insurance companies:

  • Bronze First - HMO
  • Bronze First Adult Vision & Fitness - HMO
  • Diabetes Gold - HMO
  • Diabetes Gold Adult Vision & Fitness - HMO
  • Diabetes Silver - HMO
  • Diabetes Silver Adult Vision & Fitness - HMO
  • Gold - HMO
  • Gold Adult Vision & Fitness - HMO
  • HDHP Preventive Silver - HMO
  • Healthy Heart Gold - HMO
  • Healthy Heart Gold Adult Vision & Fitness - HMO
  • Healthy Heart Silver - HMO
  • Healthy Heart Silver Adult Vision & Fitness - HMO
  • Low Premium Silver - HMO
  • Low Premium Silver Adult Vision & Fitness - HMO
  • Silver - HMO
  • Silver Adult Vision & Fitness - HMO

*Please verify directly with this provider to make sure your insurance plan is currently accepted.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

MRS. DEBBIE SUE WITT-HAGGERTY

Authorized Official Title
OFFICE MANAGER
Authorized Official Phone
(248) 624-4511

Medical Equipment Supplier

The provider carries the following medical supplies product categories:

PTAN
20554865
Accepts Medicare Assignment
YES
Specialities List
Certified Other, Pharmacy.
Competitive Bidding
NO

Supplies List

  • Blood Glucose Monitors/Supplies (Non-Mail Order) - Home blood glucose monitors including lancets, reagent strips, and other supplies necessary for the proper functioning of the device
  • Canes and/or Crutches - Standard Canes, Quad Canes, Offset Canes, Standard Crutches, Forearm Crutches
  • Walkers - Standard Walkers, Wheeled Walkers, Folding Walker
  • Orthoses: Off-The-Shelf - Met pads, Heel pads, Heel spur pads
  • Ostomy Supplies - Pouches, Paste, Powder, Barrier wipes
  • Urological Supplies - Catheters, Urinary collection devices
  • Nebulizer Equipment and/or Supplies - Nebulizers, Atomizers, Filters
  • Surgical Dressings - Gauze, Elastic bandages, Adhesive tape

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
23D0691773
Facility Type
Physician Office
Certificate Effective Date
February 16, 2025
Certificate Expiration Date
February 15, 2027
Laboratory Director
GARY HOLLANDER
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Pontiac Trail Medical Center to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1790901072
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
271801802014
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 7 + 1 + 8 + 0 + 1 + 8 + 0 + 2 + 0 + 1 + 4 + 24 = 58
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
60 - 58 = 22

The NPI number 1790901072 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.

Other Providers at the Same Location


The following 16 providers are registered at the same or nearby location.

NPI Name / Type Taxonomy Address
1902896749DR. GARY M HOLLANDER DO
Individual
Internal Medicine620 N PONTIAC TRL
WALLED LAKE, MI 48390
(248) 624-4511
1952310807 ROSS B FEINMAN DPM
Individual
Podiatrist (Foot & Ankle Surgery)620 N PONTIAC TRL
WALLED LAKE, MI 48390
(248) 624-4511
1174651442 CARL HENDRICKS
Individual
Pharmacist620 N PONTIAC TRL
WALLED LAKE, MI 48390
(248) 669-2776
1386772648 KAREN HENDRICKS
Individual
Pharmacist620 N PONTIAC TRL
WALLED LAKE, MI 48390
(248) 669-2776
1467602904MR. MICHAEL ANTHONY PETERS R.PH
Individual
Pharmacist620 N PONTIAC TRL
WALLED LAKE, MI 48390
(248) 669-2776
1104192327 BETH MAROKO RPH.
Individual
Pharmacist620 N PONTIAC TRL
WALLED LAKE, MI 48390
(248) 669-2776
1902159437LAKES AREA FOOT AND ANKLE CARE, PLLC
Organization
Podiatrist (Foot & Ankle Surgery)620 N PONTIAC TRL
WALLED LAKE, MI 48390
(248) 425-8124
1063881118 KERRI HERRIN
Individual
Pharmacy Technician620 N PONTIAC TRL
WALLED LAKE, MI 48390
(248) 669-2776
1699144584 LINDA HO CPHT
Individual
Pharmacy Technician620 N PONTIAC TRL PONTIAC TRAIL PHARMACY
WALLED LAKE, MI 48390
(248) 668-9737
1013364777 KYLE FOG
Individual
Student in an Organized Health Care Education/Training Program620 N PONTIAC TRL
WALLED LAKE, MI 48390
(248) 669-2776
1760845895 MADIHA SALIM MD
Individual
Internal Medicine620 N PONTIAC TRL
WALLED LAKE, MI 48390
(248) 624-4511
1619394004DR. MOHAMMAD SALEH M.D.
Individual
Internal Medicine620 N PONTIAC TRL
WALLED LAKE, MI 48390
(248) 624-4511
1205451259 NADIA PICCOLO FNP-C
Individual
Nurse Practitioner (Family)620 N PONTIAC TRL
WALLED LAKE, MI 48390
(248) 624-4511
1558770941 VALENTINA SCHONECK NP
Individual
Nurse Practitioner620 N PONTIAC TRL
WALLED LAKE, MI 48390
(248) 624-4511
1285627802 JULIE MARIE MICHELI PA C
Individual
Physician Assistant620 N PONTIAC TRL
WALLED LAKE, MI 48390
(248) 624-4511
1295491041 SELENA SHEPPARD PA-C
Individual
Physician Assistant620 N PONTIAC TRL
WALLED LAKE, MI 48390
(248) 624-4511

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1790901072, enumerated in the NPI registry as an "organization" on April 17, 2007

The provider is located at 620 N Pontiac Trl Walled Lake, Mi 48390 and the phone number is (248) 624-4511

This medical organization specializes in Family Medicine with taxonomy code 207QH0002X with a focus in Hospice and Palliative Medicine

The provider might be accepting Accepts: HAP CareSource. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.

The provider's CLIA number is 23D0691773 for a "physician office" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..

This NPI record was last updated on April 17, 2007. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.