NPIMap

Organization Active NPI

Munson Medical Group

  • Anesthesiology Physician
  • Traverse City, MI
National Provider Identifier
1972225571
Registry record updated Nov 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
MUNSON MEDICAL GROUP
Practice address
1105 Sixth St
Traverse City, MI 49684-2345
Phone
(231) 935-5000
NPI assigned
Sep 12, 2022
Last updated
Nov 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2024

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

Authorized official

Name
Bonnie Kruszka
Title
Coo Munson Physican Network
Phone
(231) 935-4995

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X
Anesthesiologist AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 367H00000X

Addresses

Primary practice location

1105 Sixth St
Traverse City, MI 49684-2345

Mailing address

1105 Sixth St
Traverse City, MI 49684-2345
Phone (231) 935-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110120000061 MI Part B Supplier - Clinic/Group Practice 8820277015 Receives reassigned benefits from 197 practitioners
9 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Manistee, MI; Petoskey, MI; Prudenville, MI; Sault Saint Marie, MI; Traverse City, MI; Kalkaska, MI; Cadillac, MI; Charlevoix, MI…

Other NPIs on the same Medicare enrollment 9

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

National Provider Directory

National Provider Directory
Tax ID family
Munson Medical Group5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 57

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.

  • Owen Adolphsen
    • Certified Registered Nurse Anesthetist
    • Petoskey, MI
    • NPI 1063241230

    Nurse Anesthetist, Certified Registered

    NPD
  • Mark R. Aulicino, M.D.
    • Anesthesiology Physician
    • Traverse City, MI
    • NPI 1558340737
    NPD
  • Christy Lynn Baginski, CRNA
    • Certified Registered Nurse Anesthetist
    • Detroit, MI
    • NPI 1265617278

    Nurse Anesthetist, Certified Registered

    NPD
  • Bobbi Blakeslee, RN
    • Certified Registered Nurse Anesthetist
    • Traverse City, MI
    • NPI 1609633486

    Nurse Anesthetist, Certified Registered

    NPD
  • Andrea M Brown, CRNA
    • Certified Registered Nurse Anesthetist
    • Troy, MI
    • NPI 1053390518

    Nurse Anesthetist, Certified Registered

    NPD
  • Kyle Marie Cameron, CRNA, MS
    • Certified Registered Nurse Anesthetist
    • Traverse City, MI
    • NPI 1992103212

    Nurse Anesthetist, Certified Registered

    NPD
  • Mohamad Abdul-Nabi Cheaito, CRNA
    • Certified Registered Nurse Anesthetist
    • Detroit, MI
    • NPI 1447868237

    Nurse Anesthetist, Certified Registered

    NPD
  • John D Cirocco, CRNA
    • Certified Registered Nurse Anesthetist
    • Southfield, MI
    • NPI 1841396322

    Nurse Anesthetist, Certified Registered

    NPD
  • Tyler Clack, CRNA
    • Certified Registered Nurse Anesthetist
    • Traverse City, MI
    • NPI 1891407136

    Nurse Anesthetist, Certified Registered

    NPD
  • Reid Compagner
    • Certified Registered Nurse Anesthetist
    • Traverse City, MI
    • NPI 1093490005

    Nurse Anesthetist, Certified Registered

    NPD
  • Patrick Joseph Darga
    • Anesthesiology Physician
    • Traverse City, MI
    • NPI 1679816227
    NPD
  • Sarah J Eberhard, CRNA
    • Certified Registered Nurse Anesthetist
    • Traverse City, MI
    • NPI 1548945538

    Nurse Anesthetist, Certified Registered

    NPD
View all 57

NPI Registry JSON

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

{
    "created_epoch": "1662940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730764800000",
    "number": "1972225571",
    "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": "496842345",
            "telephone_number": "231-935-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 SIXTH ST",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "496842345",
            "telephone_number": "231-935-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MUNSON MEDICAL GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-09-12",
        "last_updated": "2024-11-05",
        "certification_date": "2024-11-05",
        "status": "A",
        "authorized_official_last_name": "KRUSZKA",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_title_or_position": "COO MUNSON PHYSICAN NETWORK",
        "authorized_official_telephone_number": "231-935-4995"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiologist Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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 Nov 5, 2024; 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.