NPIMap

Organization Active NPI

Munson Medical Center

  • Sleep Medicine (Internal Medicine) Physician
  • Traverse City, MI
National Provider Identifier
1336175165
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sleep Medicine (Internal Medicine) PhysicianTaxonomy code 207RS0012X
Legal business name
MUNSON MEDICAL CENTER
Practice address
550 Munson Ave
Traverse City, MI 49686-3580
Phone
(231) 935-6600
Fax
(231) 935-9300
NPI assigned
Jun 23, 2006
Last updated
Oct 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2024

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

Authorized official

Name
Bonnie Kruszka
Title
Coo Munson Physician Network
Phone
(231) 935-4995

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sleep Medicine (Internal Medicine) Physician 207RS0012X Primary

Addresses

Primary practice location

550 Munson Ave
Traverse City, MI 49686-3580

Mailing address

1105 Sixth St
Traverse City, MI 49684-2345

Other practice location 1

1105 6th St
Traverse City, MI 49684-2349
Phone (231) 935-5000

Other identifiers 2

IdentifierTypeStateIssuer
680B860310OtherBLUE CARE NETWORK
680B860310OtherBLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20051109000463 MI Part B Supplier - Clinic/Group Practice 3072426287 Receives reassigned benefits from 34 practitioners
1 other NPI on this enrollment
Practice locations: Grayling, MI; Traverse City, MI; Manistee, MI; Kalkaska, MI; Gaylord, MI; Frankfort, MI; Charlevoix, MI; Cadillac, MI

Other NPIs with the same Medicare PAC ID 11

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.

National Provider Directory

National Provider Directory
Tax ID family
Douglas J Coles MD30 organizations share this tax ID, including this one

Other organizations with this tax ID 29

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

View all 29

Practitioners & affiliated clinicians

Practitioners 34

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 34

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728000000000",
    "number": "1336175165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "550 MUNSON AVE",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496863580",
            "telephone_number": "231-935-6600",
            "fax_number": "231-935-9300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1105 6th St",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496842349",
            "country_code": "US",
            "telephone_number": "231-935-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MUNSON MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-23",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A",
        "authorized_official_last_name": "KRUSZKA",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_title_or_position": "COO MUNSON PHYSICIAN NETWORK",
        "authorized_official_telephone_number": "231-935-4995"
    },
    "taxonomies": [
        {
            "code": "207RS0012X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Sleep Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "680B860310",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "680B860310",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Oct 4, 2024; 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.