NPIMap

Organization Active NPI

Munson Healthcare Otsego Memorial Hospital

Doing business as Munson Healthcare OMH Medical Group-Lewiston RHC

  • Rural Health Clinic/Center
  • Lewiston, MI
National Provider Identifier
1285867838
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-Lewiston RHC
OMH Medical Group Lewiston RHC
Practice address
3040 Bourn St
Lewiston, MI 49756
Phone
(989) 786-4877
Fax
(989) 786-2187
NPI assigned
Aug 31, 2009
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 Primary
Rural Acute Care Hospital 282NR1301X 238620 MI
General Practice Physician 208D00000X

Addresses

Primary practice location

3040 Bourn St
Lewiston, MI 49756

Mailing address

829 N Center Ave
Gaylord, MI 49735-1595
Phone (989) 731-2100

Other identifiers 1

IdentifierTypeStateIssuer
238620OtherCMS CERTIFICATION NUMBER

Other names 2

  • Munson Healthcare OMH Medical Group-Lewiston RHC Doing business as
  • OMH Medical Group Lewiston RHC 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
This NPI is an additional NPI on the enrollment
Practice locations: Gaylord, MI; Petoskey, MI; Lewiston, MI; Indian River, MI; Grayling, MI; Elmira, MI
O20100302000214 MI Part A Provider - Rural Health Clinic 8325942535 1 other NPI on this enrollment
Practice locations: Lewiston, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1285867838. Details of each certification follow.

Rural health clinic certification: CCN 238620

Legal name
MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Doing business as
MUNSON HEALTHCARE OMH MEDICAL GROUP LEWISTON RHC
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 21, 2009
Last certification
Feb 7, 2022
Ownership / control type
2B
Organization structure
CorporationNon-profit
Enrollment address
3040 Bourn St
Lewiston, MI 49756-8134
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

Interoperability endpoints

  • Direct secure messaging: abumbalough@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 Operational/Managerial ControlBoard Member Jan 1, 2022
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 Operational/Managerial ControlBoard Member Jan 1, 2024
Thomas Veryser Individual Corporate DirectorTrustee Jan 1, 2022
Kenneth D Bloem Individual Corporate DirectorVice Chair Jan 1, 2022
Timothy Nelson Individual Corporate DirectorTrustee Jan 1, 2022
David Menegebier Individual Operational/Managerial ControlBoard Member Jan 1, 2024
Edward Lanphier Individual Corporate DirectorBoard Member Jan 1, 2026
Kathy Dixon Individual Corporate DirectorTrustee 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 Director Jul 1, 2008
Elaine Wood Individual Corporate DirectorChair Jan 1, 2022
Claudia Rowland Individual Corporate DirectorBoard Member Jan 1, 2026
Munson Healthcare Organization, Traverse City, MI Non-profit 5% Or Greater Direct Ownership Interest Oct 2, 2019 100%
Edwin a Ness Individual Operational/Managerial ControlMHC Ceo Jul 1, 2004
Owen Roberts Individual Operational/Managerial ControlBoard Member Jan 1, 2022
Kristin S Maschke Individual W-2 Managing EmployeeMD; Jul 1, 2006
Bruce Zenner Individual Operational/Managerial ControlBoard Member Jan 1, 2022
Sakura Takano Individual Operational/Managerial ControlBoard Member Jan 1, 2022
Kristine Thomas Individual Corporate DirectorTrustee Jan 1, 2022
Brian Postma Individual Operational/Managerial ControlBoard Member Jan 1, 2022
Dino Recchia Individual Operational/Managerial ControlBoard Member Jan 1, 2024
Jennifer King Individual Operational/Managerial ControlBoard Member 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 8

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": "1251676800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776384000000",
    "number": "1285867838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "829 N CENTER AVE",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351595",
            "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": "3040 BOURN ST",
            "city": "LEWISTON",
            "state": "MI",
            "postal_code": "49756",
            "telephone_number": "989-786-4877",
            "fax_number": "989-786-2187"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-31",
        "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": null,
            "license": null,
            "primary": true
        },
        {
            "code": "282NR1301X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Rural",
            "state": "MI",
            "license": "238620",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CMS CERTIFICATION NUMBER",
            "identifier": "238620",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Munson Healthcare OMH Medical Group-Lewiston RHC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OMH Medical Group Lewiston RHC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "OMH Medical Group Lewiston RHC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lewiston, MI

Sources for this page

Verify at the official NPI Registry.