South Shore Anesthesia Staffing
Organization Active NPI Certified Registered Nurse Anesthetist · Marquette, MI
NPI 1013525112 · NPPES record last updated Sep 3, 2020
Key facts
- NPI
- 1013525112
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- Legal business name
- SOUTH SHORE ANESTHESIA STAFFING
- Practice address
- 1414 W Fair Ave Ste 235
Marquette, MI 49855-5406 - Phone
- (906) 361-4901
- NPI assigned
- Jul 15, 2020
- Organization subpart
- No
Authorized official
- Name
- Peter Skellenger, MS, CRNA
- Title
- Ceo
- Phone
- (906) 399-3611
Practitioners 20
-
Jerry Robert Jurecic, CRNA
-
Jennifer Morrow, CRNA
-
Elizabeth L Miller, CRNA
-
Christina M Barber, CRNA
-
James Christensen, CRNA
-
Jennifer L Daniel, CRNA
-
Jasmin J David, CRNA
-
Darin Hoiska, CRNA
-
John E Kus, CRNA
-
Mark McClanahan, CRNA
-
Thomas E McKenzie, CRNA
-
Kristen Tweedy, CRNA
-
Dina F Velocci, CRNA
-
Brian Stephen Videan, CRNA
-
Michael E Worden, CRNA
-
Lauren Marie Phoenix, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200819001778 | MI | Part B Supplier - Clinic/Group Practice | 0547686677 |
Receives reassigned benefits from 20 practitioners Practice locations: Marquette, MI; Munising, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist |
367500000X | Yes |
Addresses
Primary practice location
1414 W Fair Ave Ste 235
Marquette, MI 49855-5406
Mailing address
PO Box 4419
Woodland Hills, CA 91365-4419
Phone (818) 340-9988
Other practice location 1
18341 US Hwy 41
L'Anse, MI 49946-8024
Phone (906) 524-3300
NPI Registry JSON
{
"created_epoch": "1594771200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1599091200000",
"number": "1013525112",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4419",
"city": "WOODLAND HILLS",
"state": "CA",
"postal_code": "913654419",
"telephone_number": "818-340-9988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1414 W FAIR AVE STE 235",
"city": "MARQUETTE",
"state": "MI",
"postal_code": "498555406",
"telephone_number": "906-361-4901"
}
],
"practiceLocations": [
{
"address_1": "18341 US Hwy 41",
"address_purpose": "LOCATION",
"city": "L'Anse",
"state": "MI",
"postal_code": "499468024",
"country_code": "US",
"telephone_number": "906-524-3300",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "SOUTH SHORE ANESTHESIA STAFFING",
"organizational_subpart": "NO",
"enumeration_date": "2020-07-15",
"last_updated": "2020-09-03",
"certification_date": "2020-09-03",
"status": "A",
"authorized_official_last_name": "SKELLENGER",
"authorized_official_first_name": "PETER",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "906-399-3611",
"authorized_official_credential": "MS, CRNA"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Anesthetist, Certified Registered",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.