Active NPI
Munson Dialysis Center
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Traverse City, MI
National Provider Identifier
1477664993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Legal business name
- MUNSON DIALYSIS CENTER
- Practice address
- 4062 W Royal Dr
Traverse City, MI 49684-8965 - Phone
- (231) 935-0447
- Fax
- (231) 935-0467
- NPI assigned
- Aug 31, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Kathleen Laraia
- Title
- VP Ancillary Services
- Phone
- (231) 935-5000
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| End-Stage Renal Disease (ESRD) Treatment Clinic/Center | 261QE0700X | Primary |
Addresses
Primary practice location
4062 W Royal Dr
Traverse City, MI 49684-8965
Mailing address
4062 W Royal Dr
Traverse City, MI 49684-8965
Phone (231) 935-5652
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 08941 | Other | MI | BCBS DIALYSIS |
| 2937976 | Medicaid | MI | |
| 09479 | Other | MI | BCBS SECONDARY DIALYSIS |
Other names 1
- Traverse Bay Regional Dialysis Center
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050330000273 | MI | Part A Provider - End-Stage Renal Disease Facility (ESRD) | 7113973405 | Practice locations: Traverse City, MI |
Other NPIs with the same Medicare PAC ID 1
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Frankfort, MI
- NPI 1952678757
7113973405
Care Compare: Dialysis facility
Medicare Care Compare- Listed as
- Munson Dialysis Center
- Overall star rating
- Ownership
- Non-profit
- Certified
- Jan 1, 1993
- Medicare certification status
- Active
- Dialysis stations
- 18
Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D2041627 | Munson Dialysis Center | Certificate of waiver | May 24, 2028 |
National Provider Directory
National Provider Directory- Tax ID family
- Munson Dialysis Center
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- End-Stage Renal Disease (ESRD) Treatment Clinic/Center
- Frankfort, MI
- NPI 1952678757
Locations
4230 Copper Ridge Dr
Bldg E
Traverse City, MI 49684
Phone (231) 935-6382
Practitioners & affiliated clinicians
Affiliated clinicians 4
Clinicians who list this facility as an affiliation in Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1727913600000",
"number": "1477664993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4062 W ROYAL DR",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496848965",
"telephone_number": "231-935-5652",
"fax_number": "231-935-7792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4062 W ROYAL DR",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496848965",
"telephone_number": "231-935-0447",
"fax_number": "231-935-0467"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MUNSON DIALYSIS CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2006-08-31",
"last_updated": "2024-10-03",
"certification_date": "2024-10-03",
"status": "A",
"authorized_official_last_name": "LARAIA",
"authorized_official_first_name": "KATHLEEN",
"authorized_official_title_or_position": "VP ANCILLARY SERVICES",
"authorized_official_telephone_number": "231-935-5000"
},
"taxonomies": [
{
"code": "261QE0700X",
"taxonomy_group": "",
"desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS DIALYSIS",
"identifier": "08941",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2937976",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS SECONDARY DIALYSIS",
"identifier": "09479",
"state": "MI"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Traverse Bay Regional Dialysis Center",
"code": "4",
"type": "Former Legal Business Name"
}
]
}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 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.