NPIMap

Organization Active NPI

Munson Healthcare Otsego Memorial Hospital

  • General Practice Physician
  • Indian River, MI
National Provider Identifier
1053661231
Registry record updated Oct 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
Legal business name
MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Practice address
3860 S Straits Hwy
Indian River, MI 49749
Phone
(231) 238-0581
Fax
(231) 238-0856
NPI assigned
Sep 14, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 18, 2022

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

Authorized official

Name
Mrs. Ellen O Smith
Title
Ceo
Phone
(989) 731-2230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X MI Primary

Addresses

Primary practice location

3860 S Straits Hwy
Indian River, MI 49749

Mailing address

271 McCoy Rd W
Gaylord, MI 49735-8253
Phone (989) 731-7777

Other names 2

  • Munson Healthcare OMH Medical Group-Indian River Doing business as
  • OMH Medical Group - Indian River Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040305000525 MI Part B Supplier - Clinic/Group Practice 8325942535 Receives reassigned benefits from 186 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gaylord, MI; Petoskey, MI; Lewiston, MI; Indian River, MI; Grayling, MI; Elmira, MI

Other NPIs on the same Medicare enrollment 14

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

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Munson Healthcare Otsego Memorial Hospital32 organizations share this tax ID, including this one

Other organizations with this tax ID 31

Organizations that report the same tax identification number in the National Provider Directory.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1347580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666051200000",
    "number": "1053661231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "271 MCCOY RD W",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497358253",
            "telephone_number": "989-731-7777",
            "fax_number": "989-731-7776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3860 S STRAITS HWY",
            "city": "INDIAN RIVER",
            "state": "MI",
            "postal_code": "49749",
            "telephone_number": "231-238-0581",
            "fax_number": "231-238-0856"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-14",
        "last_updated": "2022-10-18",
        "certification_date": "2022-10-18",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "989-731-2230",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Munson Healthcare OMH Medical Group-Indian River",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OMH Medical Group - Indian River",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indian River, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2022; 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.