Individual provider Active NPI

Michael R. Herron, CRNA

  • Certified Registered Nurse Anesthetist
  • Pueblo, CO
National Provider Identifier
1063482859
Registry record updated Feb 26, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
35686 Issued in CO
Practice address
1008 Minnequa Ave
Pueblo, CO 81004-3733
Phone
(719) 560-5717
NPI assigned
Jan 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 26, 2016

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 35686 CO Primary

Addresses

Primary practice location

1008 Minnequa Ave
Pueblo, CO 81004-3733

Mailing address

2920 N Cascade Ave
FL 3
Colorado Springs, CO 80907-6262

Other identifiers 1

IdentifierTypeStateIssuer
97274070MedicaidCO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
35686COMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Sunset Anesthesia, LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 17, 2013 Accepting new patients
Colorado Personnel Resources Inc Past Accepting new patients
Providence Wa Anesthesia Services, P.C. Past Accepting new patients
Anesthesiology Services Network LTD Past Accepting new patients
East Valley Endoscopy LLC PastSince Jan 17, 2013 Accepting new patients
Novamed Surgery Center of Denver LLC Past Accepting new patients
Sheridan Healthcare of Colorado PC Nurse Anesthetist, Certified Registered Past Accepting new patients
Roswell Clinic Corp Past Accepting new patients
Clinical Colleagues Inc Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

6020 E Arbor Ave
Ste 105
Mesa, AZ 85206
Phone (480) 830-2005

Organizations & group practices 9

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

NPI Registry JSON

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

{
    "created_epoch": "1138060800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456444800000",
    "number": "1063482859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2920 N CASCADE AVE",
            "address_2": "FL 3",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809076262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1008 MINNEQUA AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810043733",
            "telephone_number": "719-560-5717"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERRON",
        "first_name": "MICHAEL",
        "middle_name": "R.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-24",
        "last_updated": "2016-02-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CO",
            "license": "35686",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "97274070",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.