NPIMap

Organization Active NPI

Munson Healthcare Charlevoix Hospital

  • Critical Access Hospital
  • Charlevoix, MI
National Provider Identifier
1346260692
Registry record updated Aug 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
License
150021 Issued in MI
Legal business name
MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Practice address
14700 Lake Shore Drive
Charlevoix, MI 49720-1939
Phone
(231) 547-4024
Fax
(231) 547-8088
NPI assigned
Jul 20, 2006
Organization subpart
Yes
Parent organization
MUNSON HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 16, 2024

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

Authorized official

Name
Kirsten Bethany Korth-White
Title
President/Ceo East Region
Phone
(989) 348-0720

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Access Hospital 282NC0060X 150021 MI Primary

Addresses

Primary practice location

14700 Lake Shore Drive
Charlevoix, MI 49720-1939

Mailing address

14700 Lake Shore Drive
Charlevoix, MI 49720-1939
Phone (231) 547-4024

Other identifiers 7

IdentifierTypeStateIssuer
1557598MedicaidMI
4286OtherMIPRIORITY HEALTH
00095OtherMIBLUE CARE NETWORK
1001019OtherMINORTHERN HEALTH PLAN
5170308MedicaidMI
00095OtherMIBLUE CROSS HOSP
134141100OtherMICOMP CARRIER US POSTAL SV

Medicare participation

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

Enrollment records 2

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
O20081104000688 MI Part A Provider - Critical Access Hospital 4284528035 Receives reassigned benefits from 1 practitioner
Practice locations: Boyne City, MI; Charlevoix, MI; East Jordan, MI

Hospital certification: CCN 231322

Legal name
MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Certification status
Active
Provider type (POS)
Hospital – Critical access hospital
Participating since
Jan 1, 2005
Last certification
Oct 22, 2004
Beds
25
Ownership / control type
Other
Organization structure
CorporationNon-profit
Incorporated
Mar 4, 1919 in MI
Enrollment address
14700 Lake Shore Dr
Charlevoix, MI 49720-1931
Other Hospital Practice Location

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 6

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Charlevoix Area HospitalCCN 231322
Type
Critical Access Hospitals
Ownership
Voluntary non-profit - Other
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Tax ID family
Charlevoix Area Hosp13 organizations share this tax ID, including this one
Part of
Munson Manor Hospitality House

Other organizations with this tax ID 12

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

Locations

14700 Lake Shore Dr
Ste B
Charlevoix, MI 49720

Ownership & related parties

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ruth Hoppe Individual Corporate OfficerChair Dec 1, 2015
Thomas Veryser Individual Corporate DirectorTrustee Jan 1, 2022
Casey G Cowell Individual Corporate DirectorTrustee Jan 1, 2022
Kathy Dixon Individual Corporate DirectorTrustee Jan 1, 2022
Elaine Wood Individual Corporate DirectorChair Jan 1, 2022
Munson Healthcare Organization, Traverse City, MI Corporation Operational/Managerial Control Dec 1, 2015 100%
Owen Roberts Individual Corporate DirectorTrustee Jan 1, 2022
Ellen O Smith Individual Corporate OfficerCeo Jan 1, 2022
Corporate DirectorCeo Jan 1, 2022
W-2 Managing EmployeeCeo Jan 1, 2022
Bruce Zenner Individual Corporate DirectorTrustee Jan 1, 2022
Tonya M Smith Individual Corporate DirectorTrustee Jan 1, 2021
Theodore Batzer Individual Corporate DirectorTrustee Jan 1, 2022

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 62

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

View all 62

Affiliated clinicians 236

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 236

NPI Registry JSON

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723766400000",
    "number": "1346260692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14700 LAKE SHORE DRIVE",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497201939",
            "telephone_number": "231-547-4024",
            "fax_number": "231-547-8088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14700 LAKE SHORE DRIVE",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497201939",
            "telephone_number": "231-547-4024",
            "fax_number": "231-547-8088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON HEALTHCARE CHARLEVOIX HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MUNSON HEALTHCARE",
        "enumeration_date": "2006-07-20",
        "last_updated": "2024-08-16",
        "certification_date": "2024-08-16",
        "status": "A",
        "authorized_official_last_name": "KORTH-WHITE",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_middle_name": "BETHANY",
        "authorized_official_title_or_position": "PRESIDENT/CEO EAST REGION",
        "authorized_official_telephone_number": "989-348-0720"
    },
    "taxonomies": [
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "MI",
            "license": "150021",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1557598",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIORITY HEALTH",
            "identifier": "4286",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CARE NETWORK",
            "identifier": "00095",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NORTHERN HEALTH PLAN",
            "identifier": "1001019",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5170308",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS HOSP",
            "identifier": "00095",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMP CARRIER US POSTAL SV",
            "identifier": "134141100",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlevoix, MI

Sources for this page

Verify at the official NPI Registry.