NPIMap

Organization Active NPI

Munson Healthcare Otsego Memorial Hospital

Doing business as MHC Great Lakes Plastic Surgery & Skin Center- Petoskey

  • Plastic Surgery Physician
  • Petoskey, MI
National Provider Identifier
1770374530
Registry record updated Apr 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL
Doing business as
MHC Great Lakes Plastic Surgery & Skin Center- Petoskey
Practice address
1619 Anderson Rd
Petoskey, MI 49770-9256
Phone
(231) 417-6000
Fax
(231) 417-6005
NPI assigned
May 13, 2025
Last updated
Apr 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 17, 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
Plastic Surgery Physician 208200000X Primary

Addresses

Primary practice location

1619 Anderson Rd
Petoskey, MI 49770-9256

Mailing address

1105 Sixth St
Traverse City, MI 49684-2386

Other names 1

  • MHC Great Lakes Plastic Surgery & Skin Center- Petoskey Doing business as

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

Locations

124 Shipp St
Gaylord, MI 49735
Phone (989) 731-7752

1507 Old 27 S
Ste B
Gaylord, MI 49735
Phone (517) 731-4111

829 N Center Ave
Ste 210
Gaylord, MI 49735
Phone (989) 731-7860

Practitioners & affiliated clinicians

Practitioners 233

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 233

NPI Registry JSON

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

{
    "created_epoch": "1747094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1776384000000",
    "number": "1770374530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 ANDERSON RD",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497709256",
            "telephone_number": "231-417-6000",
            "fax_number": "231-417-6005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON HEALTHCARE OTSEGO MEMORIAL HOSPITAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-13",
        "last_updated": "2026-04-17",
        "certification_date": "2026-04-17",
        "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": "208200000X",
            "taxonomy_group": "",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MHC Great Lakes Plastic Surgery & Skin Center- Petoskey",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Petoskey, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2026; 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.