NPIMap

Organization Active NPI

Munson Healthcare Otsego Memorial Hospital

  • General Acute Care Hospital
  • Gaylord, MI
National Provider Identifier
1124028972
Registry record updated Apr 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Acute Care HospitalTaxonomy code 282N00000X
Legal business name
MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Doing business as
Munson Healthcare Otsego Memorial Hospital
Practice address
825 N Center Ave
Gaylord, MI 49735
Phone
(989) 731-2100
Fax
(989) 731-2205
NPI assigned
Jul 22, 2005
Last updated
Apr 23, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2026

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

Authorized official

Name
Kirsten Bethany Korth-White
Title
Pres/Ceo East Region
Phone
(989) 348-0720

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Acute Care Hospital 282N00000X Primary

Addresses

Primary practice location

825 N Center Ave
Gaylord, MI 49735

Mailing address

825 N Center Ave
Gaylord, MI 49735-1592
Phone (989) 731-2100

Other identifiers 3

IdentifierTypeStateIssuer
00027OtherMIBCBS OF MI
5171593MedicaidMI
1557589MedicaidMI

Other names 1

  • Munson Healthcare Otsego Memorial Hospital Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20050301000744 MI Part B Supplier - Clinic/Group Practice 8325942535 Receives reassigned benefits from 57 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Gaylord, MI; Grayling, MI
O20070828000041 MI Part A Provider - Hospital 8325942535 Practice locations: Gaylord, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1124028972. Details of each certification follow.

Hospital certification: CCN 230133

Legal name
MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Oct 6, 2000
Beds
53
Ownership / control type
Private (not for profit)
Organization structure
CorporationNon-profit
Enrollment address
825 N Center Ave
Gaylord, MI 49735-1592
Other Hospital Practice Location
Hospital subgroups
General, Acute care, Long-term

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 7

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

Other NPIs on the same Medicare enrollment 1

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Munson Healthcare Otsego Memorial HospitalCCN 230133 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Private
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
No

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

Ownership & related parties

All disclosed owners & managing parties 22

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Andrew Page Individual Corporate OfficerTrustee Jan 1, 2024
Ruth Hoppe Individual Corporate DirectorSecretary Jan 1, 2022
Paul Konopacki Individual Corporate OfficerCfo Jan 1, 2024
W-2 Managing EmployeeCfo Jan 1, 2024
Operational/Managerial ControlCfo Jan 1, 2024
Vincent Schultz Individual Corporate OfficerTrustee Jan 1, 2024
Thomas Veryser Individual Corporate DirectorTrustee Jul 1, 2022
Kenneth D Bloem Individual Corporate DirectorTrustee Jan 1, 2022
Timothy Nelson Individual Corporate DirectorTreasurer Jan 1, 2022
Munson Healthcare Organization, Traverse City, MI Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jan 1, 2017 100%
Edward Lanphier Individual Corporate DirectorBoard Member Jan 1, 2026
Kathy Dixon Individual Corporate OfficerTrustee Jan 1, 2022
Kirsten Bethany Korth-White Individual Corporate DirectorPresident/Ceo Jan 23, 2024 100%
W-2 Managing EmployeePresident/Ceo Jan 23, 2024 100%
Mary Sanders Individual Corporate DirectorTrustee Jan 1, 2022
Elaine Wood Individual Corporate DirectorChair Jul 1, 2022
Claudia Rowland Individual Corporate DirectorBoard Member Jan 1, 2026
Edwin a Ness Individual Corporate OfficerMHC Ceo Jan 1, 2022
Owen Roberts Individual Corporate DirectorTrustee Jan 1, 2022
Bruce Zenner Individual Corporate DirectorTrustee Jul 1, 2022
Sakura Takano Individual Corporate DirectorTrustee Jan 1, 2022
Kristine Thomas Individual Corporate DirectorTrustee Jul 1, 2022
Brian Postma Individual Corporate DirectorTrustee Jan 1, 2022
Dino Recchia Individual Corporate OfficerTrustee Jan 1, 2024
Jennifer King Individual Corporate OfficerTrustee Jan 1, 2024

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

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

Affiliated clinicians 469

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 469

NPI Registry JSON

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

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776902400000",
    "number": "1124028972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 N CENTER AVE",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351592",
            "telephone_number": "989-731-2100",
            "fax_number": "989-731-2205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 N CENTER AVE",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "49735",
            "telephone_number": "989-731-2100",
            "fax_number": "989-731-2205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-22",
        "last_updated": "2026-04-23",
        "certification_date": "2026-04-23",
        "status": "A",
        "authorized_official_last_name": "KORTH-WHITE",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_middle_name": "BETHANY",
        "authorized_official_title_or_position": "PRES/CEO EAST REGION",
        "authorized_official_telephone_number": "989-348-0720"
    },
    "taxonomies": [
        {
            "code": "282N00000X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MI",
            "identifier": "00027",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5171593",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1557589",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Munson Healthcare Otsego Memorial Hospital",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gaylord, MI

Sources for this page

Verify at the official NPI Registry.