NPIMap

Organization Active NPI

Munson Healthcare Manistee Hospital

  • Anesthesiology Physician
  • Manistee, MI
National Provider Identifier
1649457771
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
MUNSON HEALTHCARE MANISTEE HOSPITAL
Practice address
1465 E Parkdale Ave
Manistee, MI 49660-9709
Phone
(231) 398-1000
NPI assigned
Jan 31, 2008
Last updated
Sep 22, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
WEST SHORE MEDICAL CENTERAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

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

Authorized official

Name
Ellen O Smith
Title
Cfo
Phone
(231) 935-6512

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207L00000X Primary
Certified Registered Nurse AnesthetistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 367500000X

Addresses

Primary practice location

1465 E Parkdale Ave
Manistee, MI 49660-9709

Mailing address

375 River St
Manistee, MI 49660-2729
Phone (231) 398-1950

Other names 1

  • West Shore Medical Center Anesthesia Other name

Medicare participation

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

Enrollment records 1

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

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1649457771. Details of each certification follow.

Hospital certification: CCN 230060

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
WEST SHORE MEDICAL CENTER
Certification status
Terminated Other: provider status change, May 29, 2009
Provider type (POS)
Hospital – Short-term
Participating since
Jul 1, 1966
Last certification
Oct 19, 2007
Beds
75
Ownership / control type
Other
Facility address
1465 E Parkdale Avenue
Manistee, MI 49660

Hospital certification: CCN 231335

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
WEST SHORE MEDICAL CENTER
Certification status
Terminated Other: provider status change, Dec 17, 2013
Provider type (POS)
Hospital – Critical access hospital
Participating since
Aug 1, 2009
Last certification
Apr 18, 2012
Beds
25
Ownership / control type
Other
Facility address
1465 E Parkdale Avenue
Manistee, MI 49660

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
Part of
Michael Ramanow Crna

Locations

1293 E Parkdale Ave
Chicago, IL 60689

3432 Reliable Pkwy
Chicago, IL 60686

1293 E Parkdale Ave
Ste 1200
Manistee, MI 49660
Phone (231) 398-1710

1293 E Parkdale Ave
Ste 1200A
Manistee, MI 49660
Phone (231) 398-0222

1293 E Parkdale Ave
Ste 2500
Manistee, MI 49660
Phone (231) 398-0222

1392 E Parkdale Ave
Manistee, MI 49660

375 River St
Manistee, MI 49660

50 Filer St
Ste 324
Manistee, MI 49660
Phone (231) 723-8221

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1201737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1663804800000",
    "number": "1649457771",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "375 RIVER ST",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496602729",
            "telephone_number": "231-398-1950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1465 E PARKDALE AVE",
            "city": "MANISTEE",
            "state": "MI",
            "postal_code": "496609709",
            "telephone_number": "231-398-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON HEALTHCARE MANISTEE HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WEST SHORE MEDICAL CENTER",
        "enumeration_date": "2008-01-31",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ELLEN",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "231-935-6512"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "West Shore Medical Center Anesthesia",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "West Shore Medical Center Anesthesia",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Manistee, MI

Sources for this page

Verify at the official NPI Registry.