NPIMap

Organization Active NPI

Munson Medical Center

Doing business as Munson Pulmonary & Critical Care of Northwest Michigan

  • Pulmonary Disease Physician
  • Traverse City, MI
National Provider Identifier
1013535046
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pulmonary Disease PhysicianTaxonomy code 207RP1001X
Legal business name
MUNSON MEDICAL CENTER
Doing business as
Munson Pulmonary & Critical Care of Northwest Michigan
Practice address
5087 N Royal Dr Ste B
Traverse City, MI 49684-6987
Phone
(231) 935-0440
Fax
(231) 935-0445
NPI assigned
Jul 7, 2020
Last updated
Oct 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Bonnie Kruszka
Title
Coo Munson Physician Network
Phone
(231) 935-4995

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pulmonary Disease Physician 207RP1001X NU Primary

Addresses

Primary practice location

5087 N Royal Dr Ste B
Traverse City, MI 49684-6987

Mailing address

PO Box 1131
Traverse City, MI 49685-1131

Other names 1

  • Munson Pulmonary & Critical Care of Northwest Michigan Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051109000463 MI Part B Supplier - Clinic/Group Practice 3072426287 Receives reassigned benefits from 34 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Grayling, MI; Traverse City, MI; Manistee, MI; Kalkaska, MI; Gaylord, MI; Frankfort, MI; Charlevoix, MI; Cadillac, MI

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Locations

5087 N Royal Dr
Traverse City, MI 49684
Phone (231) 935-0440

Practitioners & affiliated clinicians

Practitioners 16

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 16

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728000000000",
    "number": "1013535046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1131",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496851131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5087 N ROYAL DR STE B",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496846987",
            "telephone_number": "231-935-0440",
            "fax_number": "231-935-0445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-07-07",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A",
        "authorized_official_last_name": "KRUSZKA",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_title_or_position": "COO MUNSON PHYSICIAN NETWORK",
        "authorized_official_telephone_number": "231-935-4995"
    },
    "taxonomies": [
        {
            "code": "207RP1001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Pulmonary Disease",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Munson Pulmonary & Critical Care of Northwest Michigan",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.