NPIMap

Organization Active NPI

Munson Healthcare Charlevoix Hospital

  • Otolaryngology Physician
  • Charlevoix, MI
National Provider Identifier
1629154307
Registry record updated Mar 17, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
MUNSON HEALTHCARE CHARLEVOIX HOSPITAL
Practice address
14651 W. Upright St
Charlevoix, MI 49720-1226
Phone
(231) 582-4477
Fax
(231) 547-4753
NPI assigned
Oct 27, 2006
Organization subpart
Yes
Parent organization
MUNSON HEALTHCARE CHARLEVOIX HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 17, 2016

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

Authorized official

Name
Christine Wilhelm
Title
Chief Operations Officer
Phone
(231) 547-4024

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X MI
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X Primary
Surgery PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208600000X

Addresses

Primary practice location

14651 W. Upright St
Charlevoix, MI 49720-1226

Mailing address

14651 W Upright St
Charlevoix, MI 49720-1266
Phone (231) 547-4477

Other identifiers 2

IdentifierTypeStateIssuer
3196127MedicaidMI
0A51002OtherMIBLUE SHIELD GRP

Other names 1

  • Charlevoix Physician Specialists, Charlevoix Women's Healthcare Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071011000237 MI Part B Supplier - Clinic/Group Practice 4284528035 Receives reassigned benefits from 34 practitioners
2 other NPIs on this enrollment
Practice locations: Traverse City, MI; Petoskey, MI; Charlevoix, MI; Manistee, MI; Kalkaska, MI; Harbor Springs, MI; Grayling, MI; Gaylord, MI…

Other NPIs with the same Medicare PAC ID 5

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

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Tax ID family
Charlevoix Area Hosp13 organizations share this tax ID, including this one
Part of
Charlevoix Area Hosp

Other organizations with this tax ID 12

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

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Boulder Park TerraceCharlevoix, MI, CCN 235526 Skilled nursing facility 5% Or Greater Direct Ownership Interest (25%) Jun 10, 1992

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 35

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

View all 35

NPI Registry JSON

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

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458172800000",
    "number": "1629154307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14651 W UPRIGHT ST",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497201266",
            "telephone_number": "231-547-4477",
            "fax_number": "231-547-4753"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14651 W. UPRIGHT ST",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497201226",
            "telephone_number": "231-582-4477",
            "fax_number": "231-547-4753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON HEALTHCARE CHARLEVOIX HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MUNSON HEALTHCARE CHARLEVOIX HOSPITAL",
        "enumeration_date": "2006-10-27",
        "last_updated": "2016-03-17",
        "status": "A",
        "authorized_official_last_name": "WILHELM",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "231-547-4024"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "MI",
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208600000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Surgery",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3196127",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD GRP",
            "identifier": "0A51002",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Charlevoix Physician Specialists, Charlevoix Women's Healthcare",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlevoix, MI

Sources for this page

Verify at the official NPI Registry.