NPIMap

Organization Active NPI

Munson Medical Center

Doing business as Endocrinology and Metabolism

  • Endocrinology, Diabetes & Metabolism Physician
  • Traverse City, MI
National Provider Identifier
1083761860
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X
Legal business name
MUNSON MEDICAL CENTER
Doing business as
Endocrinology and Metabolism
Practice address
1221 Sixth St Ste 208
Traverse City, MI 49684-2360
Phone
(231) 935-2045
Fax
(231) 935-2046
NPI assigned
Jan 4, 2007
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
Endocrinology, Diabetes & Metabolism Physician 207RE0101X Primary

Addresses

Primary practice location

1221 Sixth St Ste 208
Traverse City, MI 49684-2360

Mailing address

2513 Momentum PL
Chicago, IL 60689-5325
Phone (231) 935-6080

Other identifiers 3

IdentifierTypeStateIssuer
0B81243OtherMIBCBS GROUP
0B86016OtherMIBCBS GROUP NUMBER
CB9942OtherMIRAILROAD

Other names 1

  • Endocrinology and Metabolism Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040108000904 MI Part B Supplier - Clinic/Group Practice 3072426287 Receives reassigned benefits from 568 practitioners
29 other NPIs on this enrollment
Practice locations: Manistee, MI; Traverse City, MI; Cadillac, MI; Charlevoix, MI; Cheboygan, MI; Elk Rapids, MI; Frankfort, MI; Gaylord, MI…

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 29

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

View all 29

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
23D2163941MMC Endocrinology & Metabolism1221 Sixth Street Suite 208, Traverse City, MI 49684Certificate of waiverOct 13, 2027

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: aquiring@direct.mhc.net
  • Direct secure messaging: jbrunner@direct.mhc.net
  • Direct secure messaging: kgiese@direct.mhc.net
  • Direct secure messaging: tchun2@direct.mhc.net

Practitioners & affiliated clinicians

Practitioners 573

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 573

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728000000000",
    "number": "1083761860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2513 MOMENTUM PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606895325",
            "telephone_number": "231-935-6080",
            "fax_number": "231-935-6081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1221 SIXTH ST STE 208",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842360",
            "telephone_number": "231-935-2045",
            "fax_number": "231-935-2046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "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": "207RE0101X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP",
            "identifier": "0B81243",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS GROUP NUMBER",
            "identifier": "0B86016",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "CB9942",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Endocrinology and Metabolism",
            "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.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.