NPIMap

Organization Active NPI

Munson Medical Center

  • Specialty Pharmacy
  • Traverse City, MI
National Provider Identifier
1194425447
Registry record updated Dec 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Specialty PharmacyTaxonomy code 3336S0011X
Legal business name
MUNSON MEDICAL CENTER
Practice address
Foster Family Community Health Center
550 Munson Ave Unit 4
Traverse City, MI 49686
Phone
(231) 935-8736
Fax
(231) 213-8716
NPI assigned
Mar 6, 2023
Organization subpart
Yes
Parent organization
MUNSON MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 29, 2023

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

Authorized official

Name
Kathleen Laraia
Title
VP, Ancillary Services
Phone
(231) 392-8410

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Retail Pharmacy 3336C0003X
Specialty Pharmacy 3336S0011X Primary

Addresses

Primary practice location

Foster Family Community Health Center
550 Munson Ave Unit 4
Traverse City, MI 49686

Mailing address

Foster Family Community Health Center
550 Munson Ave Unit 4
Traverse City, MI 49686
Phone (231) 935-8736

Other identifiers 1

IdentifierTypeStateIssuer
5171477MedicaidMI

Other names 1

  • Munson Healthcare Specialty Pharmacy Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240307000482 MI DME Supplier - Pharmacy 3072426287 Practice locations: Traverse City, MI

Other NPIs with the same Medicare PAC ID 11

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

National Provider Directory

National Provider Directory
Tax ID family
Leroy Futterer MD28 organizations share this tax ID, including this one
Part of
Leroy Futterer MD

Other organizations with this tax ID 27

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

View all 27

Practitioners 377

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 377

NPI Registry JSON

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

{
    "created_epoch": "1678060800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703808000000",
    "number": "1194425447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "FOSTER FAMILY COMMUNITY HEALTH CENTER",
            "address_2": "550 MUNSON AVE UNIT 4",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49686",
            "telephone_number": "231-935-8736",
            "fax_number": "231-213-8716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "FOSTER FAMILY COMMUNITY HEALTH CENTER",
            "address_2": "550 MUNSON AVE UNIT 4",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49686",
            "telephone_number": "231-935-8736",
            "fax_number": "231-213-8716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MUNSON MEDICAL CENTER",
        "enumeration_date": "2023-03-06",
        "last_updated": "2023-12-29",
        "certification_date": "2023-12-29",
        "status": "A",
        "authorized_official_last_name": "LARAIA",
        "authorized_official_first_name": "KATHLEEN",
        "authorized_official_title_or_position": "VP, ANCILLARY SERVICES",
        "authorized_official_telephone_number": "231-392-8410"
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336S0011X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Specialty Pharmacy",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5171477",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Munson Healthcare Specialty Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Munson Healthcare Specialty Pharmacy",
            "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 Dec 29, 2023; 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.