NPIMap

Organization Active NPI

Munson Healthcare Otsego Memorial Hospital

Doing business as Munson Healthcare OMH Walk-In Clinic

  • General Practice Physician
  • Gaylord, MI
National Provider Identifier
1487791695
Registry record updated Aug 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
690020 Issued in MI
Legal business name
MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Doing business as
Munson Healthcare OMH Walk-In Clinic
Practice address
1996 Walden Dr
Gaylord, MI 49735
Phone
(989) 731-4111
Fax
(989) 705-8511
NPI assigned
Jan 30, 2007
Last updated
Aug 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2018

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

Authorized official

Name
Mr. Thomas R. Lemon
Title
Ceo
Phone
(989) 731-2230

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X 690020 MI Primary

Addresses

Primary practice location

1996 Walden Dr
Gaylord, MI 49735

Mailing address

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

Other names 2

  • Munson Healthcare OMH Walk-In Clinic Doing business as
  • MedCare WalkIn Clinic Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI

Enrollment records 1

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

Other NPIs on the same Medicare enrollment 14

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

View all 14

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

NPI Registry JSON

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1534896000000",
    "number": "1487791695",
    "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": "989-731-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1996 WALDEN DR",
            "city": "GAYLORD",
            "state": "MI",
            "postal_code": "49735",
            "telephone_number": "989-731-4111",
            "fax_number": "989-705-8511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-30",
        "last_updated": "2018-08-22",
        "status": "A",
        "authorized_official_last_name": "LEMON",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "989-731-2230",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "MI",
            "license": "690020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Munson Healthcare OMH Walk-In Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MedCare WalkIn Clinic",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "MedCare WalkIn Clinic",
            "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 Aug 22, 2018; 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.