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
- 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.
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. | |||||||||
| 1 | 7 | 9 | 0 | 9 | 0 | 1 | 0 | 7 | 2 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 7 | 18 | 0 | 18 | 0 | 2 | 0 | 14 | |
| 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 = 2 | 2 | ||||||||
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 |
|---|---|---|---|
| 1902896749 | DR. GARY M HOLLANDER DO Individual | Internal Medicine | 620 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 | Pharmacist | 620 N PONTIAC TRL WALLED LAKE, MI 48390 (248) 669-2776 |
| 1386772648 | KAREN HENDRICKS Individual | Pharmacist | 620 N PONTIAC TRL WALLED LAKE, MI 48390 (248) 669-2776 |
| 1467602904 | MR. MICHAEL ANTHONY PETERS R.PH Individual | Pharmacist | 620 N PONTIAC TRL WALLED LAKE, MI 48390 (248) 669-2776 |
| 1104192327 | BETH MAROKO RPH. Individual | Pharmacist | 620 N PONTIAC TRL WALLED LAKE, MI 48390 (248) 669-2776 |
| 1902159437 | LAKES 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 Technician | 620 N PONTIAC TRL WALLED LAKE, MI 48390 (248) 669-2776 |
| 1699144584 | LINDA HO CPHT Individual | Pharmacy Technician | 620 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 Program | 620 N PONTIAC TRL WALLED LAKE, MI 48390 (248) 669-2776 |
| 1760845895 | MADIHA SALIM MD Individual | Internal Medicine | 620 N PONTIAC TRL WALLED LAKE, MI 48390 (248) 624-4511 |
| 1619394004 | DR. MOHAMMAD SALEH M.D. Individual | Internal Medicine | 620 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 Practitioner | 620 N PONTIAC TRL WALLED LAKE, MI 48390 (248) 624-4511 |
| 1285627802 | JULIE MARIE MICHELI PA C Individual | Physician Assistant | 620 N PONTIAC TRL WALLED LAKE, MI 48390 (248) 624-4511 |
| 1295491041 | SELENA SHEPPARD PA-C Individual | Physician Assistant | 620 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].
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