NPIMap

Organization Active NPI

Munson Healthcare Manistee Hospital

Doing business as Munson Healthcare - Manistee Family Care

  • Rural Health Clinic/Center
  • Manistee, MI
National Provider Identifier
1487010609
Registry record updated Apr 20, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MUNSON HEALTHCARE MANISTEE HOSPITAL
Doing business as
Munson Healthcare - Manistee Family Care
Practice address
1391 E Parkdale Ave
Manistee, MI 49660-9352
Phone
(231) 398-1760
NPI assigned
Jan 4, 2016
Last updated
Apr 20, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
MUNSON HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 20, 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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

1391 E Parkdale Ave
Manistee, MI 49660-9352

Mailing address

1391 E Parkdale Ave
Manistee, MI 49660-9352
Phone (231) 398-1878

Other names 1

  • MUNSON HEALTHCARE - MANISTEE FAMILY CARE Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040119000647 MI Part B Supplier - Clinic/Group Practice 3072414333 Receives reassigned benefits from 68 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Manistee, MI; Frankfort, MI; Cadillac, MI
O20160202002168 MI Part A Provider - Rural Health Clinic 3072414333 Practice locations: Manistee, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487010609. Details of each certification follow.

Rural health clinic certification: CCN 238692

Legal name
MUNSON HEALTHCARE MANISTEE HOSPITAL
Doing business as
MUNSON HEALTHCARE - MANISTEE FAMILY CARE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 25, 2016
Last certification
Jul 25, 2016
Ownership / control type
Non-profit – church related
Organization structure
CorporationNon-profit
Enrollment address
1391 E Parkdale Ave
Manistee, MI 49660-9352
Related CCNs
230303

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 4

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

National Provider Directory

National Provider Directory
Tax ID family
Munson Healthcare Manistee2 organizations share this tax ID, including this one
Part of
Munson Manor Hospitality House

Other organizations with this tax ID 1

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

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
Kimberly Morley Individual Corporate OfficerTrustee Jan 1, 2022
Andrew Page Individual Corporate OfficerTrustee Jan 1, 2024
Ruth Hoppe Individual Corporate OfficerSecretary 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 Corporate OfficerTrustee Jan 1, 2024
Thomas Veryser Individual Corporate OfficerTrustee Jan 1, 2022
Kenneth D Bloem Individual Corporate OfficerTrustee Jan 1, 2022
Timothy Nelson Individual Corporate OfficerTreasurer Jan 1, 2022
David Menegebier Individual Corporate OfficerTrustee Jan 1, 2024
Nicholas E Ceglarek Individual Corporate OfficerTrustee Jan 1, 2022
Kathy Dixon Individual Corporate OfficerTrustee Jan 1, 2022
Mary Sanders Individual Corporate OfficerTrustee Jan 1, 2022
Elaine Wood Individual Corporate OfficerTrustee Jan 1, 2022
Munson Healthcare Organization, Traverse City, MI Corporation Operational/Managerial Control Apr 1, 2017 100%
Peter E Marinoff Individual Corporate DirectorPresident/Ceo Jan 23, 2024 100%
W-2 Managing EmployeePresident/Ceo Jan 23, 2024 100%
Edwin a Ness Individual Corporate OfficerCeo Apr 1, 2017
Owen Roberts Individual Corporate OfficerTrustee Jan 1, 2022
Matthew Bulloch Individual Corporate OfficerTrustee Jan 1, 2023
Bruce Zenner Individual Corporate OfficerTrustee Jan 1, 2022
Sakura Takano Individual Corporate OfficerTrustee Jan 1, 2022
Kristine Thomas Individual Corporate OfficerTrustee Jan 1, 2022
Brian Postma Individual Corporate DirectorTrustee Apr 1, 2017
Dino Recchia Individual Corporate OfficerTrustee Jan 1, 2024
Jennifer King Individual Corporate OfficerTrustee Jan 1, 2024

Owners & managing parties with NPI records 2

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 6

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": "1451865600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776643200000",
    "number": "1487010609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1391 E PARKDALE AVE",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496609352",
            "telephone_number": "231-398-1878",
            "fax_number": "231-398-1768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1391 E PARKDALE AVE",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496609352",
            "telephone_number": "231-398-1760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON HEALTHCARE MANISTEE HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MUNSON HEALTHCARE",
        "enumeration_date": "2016-01-04",
        "last_updated": "2026-04-20",
        "certification_date": "2026-04-20",
        "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
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MUNSON HEALTHCARE - MANISTEE FAMILY CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Manistee, MI

Sources for this page

Verify at the official NPI Registry.