Individual provider Active NPI

Jason Ford, CRNA

  • Certified Registered Nurse Anesthetist
  • Niles, MI
National Provider Identifier
1063463933
Registry record updated Jun 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704267914 Issued in MI
Practice address
31 N Saint Joseph Ave
Niles, MI 49120
Phone
(269) 687-1879
Fax
(269) 683-0104
NPI assigned
May 15, 2006
Last updated
Jun 24, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2024

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 28165863 IN
Certified Registered Nurse Anesthetist 367500000X 4704267914 MI Primary

Addresses

Primary practice location

31 N Saint Joseph Ave
Niles, MI 49120

Mailing address

31 N Saint Joseph Ave
Niles, MI 49120-2207
Phone (269) 687-1879

Other practice location 1

500 N Nappanee St
Suite 11B
Elkhart, IN 46514-1503
Phone (574) 522-9922

Other identifiers 1

IdentifierTypeStateIssuer
200539770MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051205000819 IN Practitioner - Certified Registered Nurse Anesthetist (Crna) 0446270474 Reassigns benefits to 2 organizations
I20090121000231 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 0446270474 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1234 Napier Ave
Corewell Health Lakeland Hospitals
Saint Joseph, MI 49085-2112
Phone (269) 983-8300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28165863INMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Lakeland Community Hospital Watervliet Current Accepting new patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc Current Accepting new patients
Pathology Assoc of Southwestern Michigan, PC Current Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc Current Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Nov 3, 2019 Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc CurrentSince Feb 12, 2021 Accepting new patients
Anesthesia Associates of Laporte PC CurrentSince Dec 30, 2023 Accepting new patients
Lakeland Community Hospital Watervliet CurrentSince Nov 3, 2019 Accepting new patients
Lakeland Hospitals at Niles and St Joseph, Inc Nurse Anesthetist, Certified Registered CurrentSince Feb 12, 2021 Accepting new patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2022 Accepting new patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc. CurrentSince Aug 1, 2022 Accepting new patients

Locations

102 E Culver Rd
Knox, IN 46534
Phone (574) 772-1580

1331 State St
Laporte, IN 46350
Phone (219) 326-2415

5215 Holy Cross Pkwy
Mishawaka, IN 46545
Phone (574) 335-2443

420 W High St
Dowagiac, MI 49047
Phone (269) 782-8681

31 N Saint Joseph Ave
Niles, MI 49120
Phone (269) 428-2417

1234 Napier Ave
Saint Joseph, MI 49085
Phone (269) 982-4941

400 Medical Park Dr
Watervliet, MI 49098
Phone (269) 463-3111

Interoperability endpoints

  • FHIR API: https://epicarr02.spectrumhealth.org/EpicFHIR/api/FHIR/R4/
  • Direct secure messaging: jford1844614@direct.trinity-health.org

Organizations & group practices 11

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": "1147651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719187200000",
    "number": "1063463933",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31 N SAINT JOSEPH AVE",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202207",
            "telephone_number": "269-687-1879",
            "fax_number": "269-683-0104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31 N SAINT JOSEPH AVE",
            "city": "NILES",
            "state": "MI",
            "postal_code": "49120",
            "telephone_number": "269-687-1879",
            "fax_number": "269-683-0104"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 N Nappanee St",
            "address_2": "Suite 11B",
            "address_purpose": "LOCATION",
            "city": "Elkhart",
            "state": "IN",
            "postal_code": "465141503",
            "country_code": "US",
            "telephone_number": "574-522-9922",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORD",
        "first_name": "JASON",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-15",
        "last_updated": "2024-06-24",
        "certification_date": "2024-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "28165863",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704267914",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200539770",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; 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.