NPIMap

Organization Active NPI

Munson Healthcare Cadillac

Doing business as Munson Healthcare Cadillac Physician Network

  • Family Medicine Physician
  • Cadillac, MI
National Provider Identifier
1487051611
Registry record updated Sep 1, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MUNSON HEALTHCARE CADILLAC
Doing business as
Munson Healthcare Cadillac Physician Network
Practice address
400 Hobart St
Cadillac, MI 49601-2331
Phone
(231) 876-7234
Fax
(231) 876-7176
NPI assigned
Dec 3, 2014
Last updated
Sep 1, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
MUNSON HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 1, 2026

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

Authorized official

Name
Michael Frye
Title
Pres. Ambulatory & Bus. Development
Phone
(704) 458-8010

Specialties & licenses 9

Specialty (taxonomy)CodeLicenseStatePrimary
Infusion Therapy Clinic/Center 261QI0500X
Adult Health Nurse Practitioner 363LA2200X MI
Family Nurse Practitioner 363LF0000X MI
Infusion Therapy Registered Nurse 163WI0500X
Family Medicine Physician 207Q00000X MI Primary
Internal Medicine Physician 207R00000X MI
Cardiovascular Disease Physician 207RC0000X MI
Hematology & Oncology Physician 207RH0003X MI
Obstetrics & Gynecology Physician 207V00000X MI

Addresses

Primary practice location

400 Hobart St
Cadillac, MI 49601-2331

Mailing address

400 Hobart St
Cadillac, MI 49601-2331
Phone (231) 876-7234

Other practice location 1

217 S Madison St
Traverse City, MI 49684-2321
Phone (231) 392-8400

Other practice location 2

701 N Otsego Ave
Gaylord, MI 49735-1558
Phone (989) 731-7760

Other practice location 3

1465 E Parkdale Ave
Manistee, MI 49660-9709
Phone (231) 876-6421

Other names 1

  • Munson Healthcare Cadillac Physician Network Doing business as

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20150211000241 MI Part A Provider - Hospital 6305161514 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Cadillac, MI; Traverse City, MI
O20150401000808 MI Part B Supplier - Clinic/Group Practice 6305161514 Receives reassigned benefits from 174 practitioners
7 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Frankfort, MI; Traverse City, MI; MC Bain, MI; Manistee, MI; Kalkaska, MI; Grayling, MI; Gaylord, MI; Charlevoix, MI…

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487051611. Details of each certification follow.

Hospital certification: CCN 230081

Legal name
MUNSON HEALTHCARE CADILLAC
Certification status
Active
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Jan 7, 1988
Beds
117
Ownership / control type
Church
Most recent change of ownership
Feb 1, 2015 (1 total)
Organization structure
CorporationNon-profit
Incorporated
Jun 17, 2014 in MI
Enrollment address
400 Hobart St
Cadillac, MI 49601-2331
Other Hospital Practice Location
Hospital subgroups
Acute care

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

Other NPIs on the same Medicare enrollment 8

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

Care Compare: Hospital

Medicare Care Compare
Listed as
Munson Healthcare Cadillac HospitalCCN 230081 · All quality measures
Overall star rating
4 of 5
Type
Acute Care Hospitals
Ownership
Voluntary non-profit - Church
Medicare certification status
ActiveFrom the Provider of Services file
Emergency services
Yes

National Provider Directory

National Provider Directory
Part of
Munson Manor Hospitality House

Locations

8872 Professional Dr
Cadillac, MI 49601
Phone (231) 779-0320

1110 Sixth St
Traverse City, MI 49684
Phone (231) 392-8400

2800 W Big Beaver Rd
Ste V-368
Troy, MI 48084
Phone (248) 816-0990

Ownership & related parties

All disclosed owners & managing parties 22

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

NameRoleSinceShare
Andrew Page Individual Corporate OfficerTrustee Jan 1, 2024
Ruth Hoppe Individual Corporate DirectorTrustee Jan 1, 2022
Paul Konopacki Individual Corporate OfficerCfo Jan 1, 2024
W-2 Managing Employee Jan 1, 2024
Operational/Managerial ControlCfo Jan 1, 2024
Vincent Schultz Individual Corporate OfficerTrustee Jan 1, 2024
Thomas Veryser Individual Corporate DirectorTrustee Jan 1, 2022
Kenneth D Bloem Individual Corporate DirectorTrustee Jan 1, 2022
Timothy Nelson Individual Corporate DirectorTreasurer Jan 1, 2022
David Menegebier Individual Corporate OfficerTrustee Jan 1, 2024
Edward Lanphier Individual Corporate DirectorBoard Member Jan 1, 2026
Kathy Dixon Individual Corporate DirectorTrustee Jan 1, 2022
Mary Sanders Individual Corporate DirectorTrustee Jan 1, 2022
Elaine Wood Individual Corporate DirectorTrustee Jan 1, 2022
Munson Healthcare Organization, Traverse City, MI Corporation Operational/Managerial Control Feb 1, 2015 100%
Peter E Marinoff Individual Corporate Director Dec 13, 2023 100%
W-2 Managing Employee Jan 1, 2022
Edwin a Ness Individual Corporate OfficerCeo Jul 1, 2004
Owen Roberts Individual Corporate OfficerVice Chairperson Feb 1, 2015
Corporate DirectorTrustee Jan 1, 2022
Bruce Zenner Individual Corporate DirectorTrustee Jan 1, 2022
Sakura Takano Individual Corporate DirectorTrustee Jan 1, 2022
Kristine Thomas Individual Corporate DirectorTrustee Jan 1, 2022
Brian Postma Individual Corporate DirectorTrustee Jan 1, 2022
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.

Practitioners & affiliated clinicians

Practitioners 45

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 45

Affiliated clinicians 515

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

View all 515

NPI Registry JSON

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

{
    "created_epoch": "1417564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1788220800000",
    "number": "1487051611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 HOBART ST",
            "city": "CADILLAC",
            "state": "MI",
            "postal_code": "496012331",
            "telephone_number": "231-876-7234",
            "fax_number": "231-876-7176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 HOBART ST",
            "city": "CADILLAC",
            "state": "MI",
            "postal_code": "496012331",
            "telephone_number": "231-876-7234",
            "fax_number": "231-876-7176"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "217 S Madison St",
            "address_purpose": "LOCATION",
            "city": "Traverse City",
            "state": "MI",
            "postal_code": "496842321",
            "country_code": "US",
            "telephone_number": "231-392-8400",
            "fax_number": "231-392-8467",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "701 N Otsego Ave",
            "address_purpose": "LOCATION",
            "city": "Gaylord",
            "state": "MI",
            "postal_code": "497351558",
            "country_code": "US",
            "telephone_number": "989-731-7760",
            "fax_number": "989-731-7748",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1465 E Parkdale Ave",
            "address_purpose": "LOCATION",
            "city": "Manistee",
            "state": "MI",
            "postal_code": "496609709",
            "country_code": "US",
            "telephone_number": "231-876-6421",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MUNSON HEALTHCARE CADILLAC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MUNSON HEALTHCARE",
        "enumeration_date": "2014-12-03",
        "last_updated": "2026-09-01",
        "certification_date": "2026-09-01",
        "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"
    },
    "taxonomies": [
        {
            "code": "261QI0500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "163WI0500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Infusion Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": null,
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Munson Healthcare Cadillac Physician Network",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Munson Healthcare Cadillac Physician Network",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cadillac, MI

Sources for this page

Verify at the official NPI Registry.