Individual provider Active NPI

Michael Dale Lance II, CRNA

  • Certified Registered Nurse Anesthetist
  • Louisville, KY
National Provider Identifier
1063032001
Registry record updated Aug 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3014694 Issued in KY
Practice address
530 S Jackson St
Louisville, KY 40202-1675
Phone
(502) 852-1735
Fax
(502) 852-6056
NPI assigned
Apr 20, 2020
Last updated
Aug 5, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 3014694 KY Primary

Addresses

Primary practice location

530 S Jackson St
Louisville, KY 40202-1675

Mailing address

PO Box 909
Louisville, KY 40201-0909
Phone (502) 588-0328

Other practice location 1

200 Abraham Flexner Way
Louisville, KY 40202-2877
Phone (502) 587-4044

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200729002255 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 1052736733 Reassigns benefits to 2 organizations
I20240405001312 IN Practitioner - Certified Registered Nurse Anesthetist (Crna) 1052736733 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Apollo Medical Group of Jeffersonville LLCGroup PAC ID 8729487897, 25 clinicians

Practice addresses (Care Compare)

400 Corporate Dr
Suite 100
Jeffersonville, IN 47130-1502
Phone (812) 925-1051

Merit-based Incentive Payment System (MIPS)

Final score
78.96 of 100Reported as group
Quality
56.12
Promoting interoperability
100
Improvement activities
40
Cost
73.73

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
University of Louisivlle Physicians CurrentSince Aug 3, 2020 Accepting new patients
Ema Anesthesia, PSC Nurse Anesthetist, Certified Registered CurrentSince Jan 16, 2024 Accepting new patients
University of Louisville Physicians, Inc. CurrentSince Aug 3, 2020 Accepting new patients
University of Louisville Physicians, Inc. Current Accepting new patients

Locations

7752 Solution Ctr
Chicago, IL 60677

360 Missouri Ave
Ste 102
Jeffersonvlle, IN 47130
Phone (502) 364-0902

101 Financial Pl
Ste B103
Elizabethtown, KY 42701
Phone (270) 307-8177

1 Audubon Plaza Dr
Louisville, KY 40217
Phone (502) 634-6767

1169 Eastern Pkwy
Ste 400
Louisville, KY 40217
Phone (502) 276-5554

200 Abraham Flexner Way
Louisville, KY 40202
Phone (502) 569-7983

530 S Jackson St
Louisville, KY 40202
Phone (502) 562-3000

571 S Floyd St
Louisville, KY 40202
Phone (502) 561-2700

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.

NPI Registry JSON

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

{
    "created_epoch": "1587340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1596585600000",
    "number": "1063032001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 909",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402010909",
            "telephone_number": "502-588-0328",
            "fax_number": "502-587-4784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 S JACKSON ST",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402021675",
            "telephone_number": "502-852-1735",
            "fax_number": "502-852-6056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Abraham Flexner Way",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402022877",
            "country_code": "US",
            "telephone_number": "502-587-4044",
            "fax_number": "502-587-4156",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LANCE",
        "first_name": "MICHAEL",
        "middle_name": "DALE",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-20",
        "last_updated": "2020-08-05",
        "certification_date": "2020-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3014694",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2020; 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.