NPIMap

Organization Active NPI

Munson Healthcare Otsego Memorial Hospital

Doing business as Munson Healthcare OMH Medical Group-Gaylord RHC

  • Rural Health Clinic/Center
  • Gaylord, MI
National Provider Identifier
1164628426
Registry record updated Apr 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Doing business as
Munson Healthcare OMH Medical Group-Gaylord RHC
Otsego Memorial Hospital Rural Health Clinic
Practice address
829 N Center Ave
Gaylord, MI 49735
Phone
(989) 731-7708
Fax
(989) 731-7929
NPI assigned
Jun 25, 2007
Last updated
Apr 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2026

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

Authorized official

Name
Michael Frye, MD
Title
Pres. Ambulatory & Bus. Development
Phone
(704) 458-8010

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary
Rural Acute Care Hospital 282NR1301X 238607 MI
General Practice Physician 208D00000X NU

Addresses

Primary practice location

829 N Center Ave
Gaylord, MI 49735

Mailing address

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

Other identifiers 1

IdentifierTypeStateIssuer
23-8607OtherCMS CERTIFICATION NUMBER

Other names 2

  • Munson Healthcare OMH Medical Group-Gaylord RHC Doing business as
  • Otsego Memorial Hospital Rural Health Clinic Doing business as

Medicare participation

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

Enrollment records 2

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
Practice locations: Gaylord, MI; Petoskey, MI; Lewiston, MI; Indian River, MI; Grayling, MI; Elmira, MI
O20060616000082 MI Part A Provider - Rural Health Clinic 8325942535 Practice locations: Gaylord, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1164628426. Details of each certification follow.

Rural health clinic certification: CCN 238607

Legal name
MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Doing business as
MUNSON HEALTHCARE OMH MEDICAL GROUP GAYLORD RHC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jun 6, 2007
Last certification
Apr 8, 2021
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
829 N Center Ave
Ste 210
Gaylord, MI 49735-1599
Related CCNs
230133

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 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

Locations

829 N Center Ave
Ste 130
Gaylord, MI 49735
Phone (989) 731-7930

Interoperability endpoints

  • Direct secure messaging: bpowers2@direct.mhc.net
  • Direct secure messaging: cdiedrich@direct.mhc.net
  • Direct secure messaging: clawnichak2@direct.mhc.net
  • Direct secure messaging: cli222@direct.mhc.net
  • Direct secure messaging: dminer@direct.mhc.net
  • Direct secure messaging: jatkins@direct.mhc.net
  • Direct secure messaging: jshurlow@direct.mhc.net
  • Direct secure messaging: kalexander@direct.mhc.net
  • Direct secure messaging: kmiyamoto@direct.mhc.net
  • Direct secure messaging: kpawlanta@direct.mhc.net
  • Direct secure messaging: lharden2@direct.mhc.net
  • Direct secure messaging: mmazur@direct.mhc.net
  • Direct secure messaging: mseger@direct.mhc.net
  • Direct secure messaging: pdanziger@direct.mhc.net
  • Direct secure messaging: rspellman@direct.mhc.net
  • Direct secure messaging: ssensor@direct.mhc.net
  • Direct secure messaging: swisniewski@direct.mhc.net
  • Direct secure messaging: tpardo2@direct.mhc.net

Ownership & related parties

All disclosed owners & managing parties 24

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 Officer Jan 1, 2024
Ruth Hoppe Individual Corporate Officer 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 Officer Jan 1, 2024
Thomas Veryser Individual Corporate Officer Jan 1, 2022
Kenneth D Bloem Individual Corporate Officer Jan 1, 2022
Timothy Nelson Individual Corporate Officer Jan 1, 2013
David Menegebier Individual Corporate Officer Jan 1, 2024
Edward Lanphier Individual Corporate DirectorBoard Member Jan 1, 2026
Kathy Dixon Individual Corporate Officer Jan 1, 2022
Kirsten Bethany Korth-White Individual Corporate OfficerPresident/Ceo Nov 1, 2018
W-2 Managing EmployeePresident/Ceo East Region Jun 1, 2022
Operational/Managerial ControlPresident/Ceo East Region Jun 1, 2022
Steven J Wisniewski Individual W-2 Managing EmployeeMD; Aug 2, 2004
Mary Sanders Individual Corporate Director Apr 1, 2006
Elaine Wood Individual Corporate Officer Jan 1, 2022
Claudia Rowland Individual Corporate DirectorBoard Member Jan 1, 2026
Munson Healthcare Organization, Traverse City, MI Corporation Operational/Managerial Control Oct 3, 2025
Edwin a Ness Individual Corporate Officer Jul 1, 2004
Owen Roberts Individual Corporate Officer Jan 1, 2022
Bruce Zenner Individual Corporate Officer Jan 1, 2022
Sakura Takano Individual Corporate Officer Jan 1, 2022
Kristine Thomas Individual Corporate Officer Jan 1, 2022
Brian Postma Individual Corporate Officer Jan 1, 2022
Dino Recchia Individual Corporate Officer Jan 1, 2024
Jennifer King Individual Corporate Officer Jan 1, 2024

Owners & managing parties with NPI records 3

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

Facilities with the same owner 24

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 24

Practitioners & affiliated clinicians

Practitioners 189

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 189

NPI Registry JSON

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

{
    "created_epoch": "1182729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776384000000",
    "number": "1164628426",
    "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": "989-731-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "829 N CENTER AVE",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "49735",
            "telephone_number": "989-731-7708",
            "fax_number": "989-731-7929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-25",
        "last_updated": "2026-04-17",
        "certification_date": "2026-04-17",
        "status": "A",
        "authorized_official_last_name": "FRYE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "PRES. AMBULATORY & BUS. DEVELOPMENT",
        "authorized_official_telephone_number": "704-458-8010",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "MI",
            "license": "238607",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMS CERTIFICATION NUMBER",
            "identifier": "23-8607",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Munson Healthcare OMH Medical Group-Gaylord RHC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Otsego Memorial Hospital Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Otsego Memorial Hospital Rural Health Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Gaylord, MI

Sources for this page

Verify at the official NPI Registry.