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Organization Active NPI

Munson Healthcare Charlevoix Hospital

Doing business as Munson Healthcare Boyne Area Medical Center

  • Rural Health Clinic/Center
  • Boyne City, MI
National Provider Identifier
1255779484
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 CHARLEVOIX HOSPITAL
Doing business as
Munson Healthcare Boyne Area Medical Center
Practice address
223 N Park St
Boyne City, MI 49712-1220
Phone
(231) 582-5314
Fax
(231) 582-5338
NPI assigned
Jun 10, 2013
Last updated
Apr 17, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
MUNSON HEALTHCAREAs reported in NPPES

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
President Amb & Bus Development
Phone
(704) 458-8010

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

223 N Park St
Boyne City, MI 49712-1220

Mailing address

223 N Park St
Boyne City, MI 49712-1220
Phone (231) 582-5314

Other names 1

  • Munson Healthcare Boyne Area Medical Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040211001170 MI Part B Supplier - Clinic/Group Practice 4284528035 Receives reassigned benefits from 98 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Charlevoix, MI; East Jordan, MI
O20070109000030 MI Part B Supplier - Clinic/Group Practice 4284528035 Receives reassigned benefits from 22 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Charlevoix, MI; Traverse City, MI; Manistee, MI; Kalkaska, MI; Grayling, MI; Gaylord, MI; Frankfort, MI; Cadillac, MI…
O20130722000040 MI Part A Provider - Rural Health Clinic 4284528035 Practice locations: Boyne City, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255779484. Details of each certification follow.

Rural health clinic certification: CCN 238665

Legal name
MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Doing business as
BOYNE AREA MEDICAL CENTER
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
May 13, 2014
Last certification
May 13, 2014
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
223 N Park St
Boyne City, MI 49712-1220
Related CCNs
231322

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

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 7

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

National Provider Directory

National Provider Directory
Part of
Munson Manor Hospitality House

Locations

14695 Park Ave
Ste B
Charlevoix, MI 49720
Phone (231) 547-8860

14705 W Upright St
Charlevoix, MI 49720
Phone (231) 547-6519

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
Kimberly Morley Individual Other Jan 1, 2022
Andrew Page Individual Corporate OfficerTrustee Jan 1, 2024
Ruth Hoppe Individual Other 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 OfficerTrustee Jan 1, 2022
Kenneth D Bloem Individual Other Jan 1, 2022
Timothy Nelson Individual Other Jan 1, 2022
David Menegebier Individual Corporate OfficerTrustee Jan 1, 2024
Nicholas E Ceglarek Individual Other Jan 1, 2022
Kathy Dixon Individual Other 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 OfficerTrustee Jan 1, 2022
Elaine Wood Individual Corporate OfficerTrustee Jan 1, 2022
Munson Healthcare Organization, Traverse City, MI Corporation Operational/Managerial Control Dec 1, 2015 100%
Edwin a Ness Individual Corporate DirectorCeo Feb 15, 2015
Owen Roberts Individual Corporate OfficerTrustee Jan 1, 2022
Matthew Bulloch Individual Corporate OfficerTrustee Jan 1, 2023
Bruce Zenner Individual Corporate OfficerTrustee Jan 1, 2022
Sakura Takano Individual Corporate OfficerTrustee Jan 1, 2022
Kristine Thomas Individual Corporate OfficerTrustee Jan 1, 2022
Brian Postma Individual Corporate OfficerTrustee 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.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Boulder Park TerraceCharlevoix, MI, CCN 235526 Skilled nursing facility 5% Or Greater Direct Ownership Interest (25%) Jun 10, 1992

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1370822400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776384000000",
    "number": "1255779484",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "223 N PARK ST",
            "city": "BOYNE CITY",
            "state": "MI",
            "postal_code": "497121220",
            "telephone_number": "231-582-5314",
            "fax_number": "231-582-5338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 N PARK ST",
            "city": "BOYNE CITY",
            "state": "MI",
            "postal_code": "497121220",
            "telephone_number": "231-582-5314",
            "fax_number": "231-582-5338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON HEALTHCARE CHARLEVOIX HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MUNSON HEALTHCARE",
        "enumeration_date": "2013-06-10",
        "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": "PRESIDENT AMB & BUS DEVELOPMENT",
        "authorized_official_telephone_number": "704-458-8010",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Munson Healthcare Boyne Area Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Boyne City, MI

Sources for this page

Verify at the official NPI Registry.