NPIMap

Organization Active NPI

Munson Healthcare Otsego Memorial Hospital

  • Certified Registered Nurse Anesthetist
  • Gaylord, MI
National Provider Identifier
1376568865
Registry record updated Sep 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Practice address
825 N Center Ave
Gaylord, MI 49735
Phone
(989) 731-2100
Fax
(989) 731-2205
NPI assigned
Jul 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2021

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

Authorized official

Name
Alicia Maitland
Title
Cfo
Phone
(231) 935-7840

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

825 N Center Ave
Gaylord, MI 49735

Mailing address

825 N Center Ave
Gaylord, MI 49735-1592
Phone (989) 731-2100

Other identifiers 1

IdentifierTypeStateIssuer
430F910100OtherMIBS

Other names 1

  • Otsego Memorial Hospital CRNA Other name

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
O20050301000744 MI Part B Supplier - Clinic/Group Practice 8325942535 Receives reassigned benefits from 57 practitioners
1 other NPI on this enrollment
Practice locations: Gaylord, MI; Grayling, MI

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 15

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

View all 15

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

Practitioners & affiliated clinicians

Practitioners 172

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

View all 172

NPI Registry JSON

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

{
    "created_epoch": "1152748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632268800000",
    "number": "1376568865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 N CENTER AVE",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "497351592",
            "telephone_number": "989-731-2100",
            "fax_number": "989-731-2205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 N CENTER AVE",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "49735",
            "telephone_number": "989-731-2100",
            "fax_number": "989-731-2205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-13",
        "last_updated": "2021-09-22",
        "certification_date": "2021-09-22",
        "status": "A",
        "authorized_official_last_name": "MAITLAND",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "231-935-7840"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BS",
            "identifier": "430F910100",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Otsego Memorial Hospital CRNA",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Otsego Memorial Hospital CRNA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Gaylord, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2021; 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.