NPIMap

Organization Active NPI

Munson Medical Center

  • Specialist
  • Traverse City, MI
National Provider Identifier
1952532863
Registry record updated Dec 22, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
4301084179 Issued in MI
Legal business name
MUNSON MEDICAL CENTER
Practice address
1104 Cass St
Traverse City, MI 49684-3236
Phone
(231) 941-1155
Fax
(231) 941-1347
NPI assigned
Jul 28, 2009
Last updated
Dec 22, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 22, 2009

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

Authorized official

Name
Mark A Hepler
Title
Interim Cfo
Phone
(231) 935-7767

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X 4301084179 MI Primary

Addresses

Primary practice location

1104 Cass St
Traverse City, MI 49684-3236

Mailing address

1104 Cass St
Traverse City, MI 49684-3236
Phone (231) 941-1155

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040108000904 MI Part B Supplier - Clinic/Group Practice 3072426287 Receives reassigned benefits from 568 practitioners
29 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Manistee, MI; Traverse City, MI; Cadillac, MI; Charlevoix, MI; Cheboygan, MI; Elk Rapids, MI; Frankfort, MI; Gaylord, MI…

Other NPIs on the same Medicare enrollment 29

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

View all 29

National Provider Directory

National Provider Directory
Tax ID family
Douglas J Coles MD32 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

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1248739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1261440000000",
    "number": "1952532863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1104 CASS ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496843236",
            "telephone_number": "231-941-1155",
            "fax_number": "231-941-1347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1104 CASS ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496843236",
            "telephone_number": "231-941-1155",
            "fax_number": "231-941-1347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-07-28",
        "last_updated": "2009-12-22",
        "status": "A",
        "authorized_official_last_name": "HEPLER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "INTERIM CFO",
        "authorized_official_telephone_number": "231-935-7767"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MI",
            "license": "4301084179",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2009; 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.