Individual provider Active NPI

Glen Michael Cavalier, CRNA

  • Certified Registered Nurse Anesthetist
  • Gulfport, MS
National Provider Identifier
1043288541
Registry record updated Sep 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R875676 Issued in MS
Practice address
15200 Community Rd
Gulfport, MS 39503-3085
Phone
(228) 575-7000
NPI assigned
Mar 9, 2006
Last updated
Sep 5, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 5, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 28162301A IN
Certified Registered Nurse Anesthetist 367500000X R875676 MS Primary

Addresses

Primary practice location

15200 Community Rd
Gulfport, MS 39503-3085

Mailing address

15190 Community Rd
Ste 230a
Gulfport, MS 39503-3483
Phone (228) 831-0204

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080111000530 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 3274573357 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Singing River GulfportGroup PAC ID 5294154829, 75 clinicians

Practice addresses (Care Compare)

15200 Community Rd
Gulfport, MS 39503-3085
Phone (228) 575-7000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
28162301AINMDCertified Registered Nurse Anesthetist
R875676MSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Singing River Gulfport CurrentSince Jan 1, 2023 Accepting new patients
Lifelinc Anesthesia, PLLC Nurse Anesthetist, Certified Registered CurrentSince Nov 1, 2019 Accepting new patients
Singing River Gulfport CurrentSince Jan 1, 2023 Accepting new patients
Florida Gulf-to-Bay Anesthesiology Associates, LLC Past Accepting new patients
Gulfport Outpatient Anesthesia, P.a. PastSince Mar 1, 2010 Accepting new patients

Locations

634 Leigh Dr
Columbus, MS 39705
Phone (601) 978-3393

15190 Community Rd
Ste 230A
Gulfport, MS 39503
Phone (228) 831-0204

15200 Community Rd
Gulfport, MS 39503
Phone (228) 575-7000

5001 Hardy St
Hattiesburg, MS 39402
Phone (601) 268-8000

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1567641600000",
    "number": "1043288541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15190 COMMUNITY RD",
            "address_2": "STE 230A",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033483",
            "telephone_number": "228-831-0204",
            "fax_number": "228-831-1868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15200 COMMUNITY RD",
            "city": "GULFPORT",
            "state": "MS",
            "postal_code": "395033085",
            "telephone_number": "228-575-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAVALIER",
        "first_name": "GLEN",
        "middle_name": "MICHAEL",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2019-09-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "28162301A",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "R875676",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gulfport, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.