Individual provider Active NPI

Donna A Dzialo, CRNA

  • Certified Registered Nurse Anesthetist
  • Rochester, MI
National Provider Identifier
1093868234
Registry record updated Jun 26, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704210409 Issued in MI
Practice address
1101 West University Drive
Crittenton Hospital Medical Center
Rochester, MI 48307-1863
Phone
(248) 652-5354
Fax
(248) 652-5861
NPI assigned
Jan 19, 2007
Last updated
Jun 26, 2012By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 26, 2012

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 4704210409 MI Primary

Addresses

Primary practice location

1101 West University Drive
Crittenton Hospital Medical Center
Rochester, MI 48307-1863

Mailing address

5717 Cannes Dr
Sterling Heights, MI 48314-1342

Other identifiers 3

IdentifierTypeStateIssuer
11909797OtherMICAQH
4368763MedicaidMI
430F364550OtherMIBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120119000615 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 3375710106 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Wayne State University School of Medicine, 1999
Medicare assignment
May accept Medicare assignment
Group practices
Northstar Anesthesia of Michigan III PLLCGroup PAC ID 7911325469, 561 clinicians

Practice addresses (Care Compare)

1101 W University Dr
Rochester, MI 48307-1863
Phone (248) 652-5000

33155 Annapolis St
Wayne, MI 48184-2405
Phone (214) 687-0001

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704210409MIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Macomb Hospital Corporation CurrentSince Jan 5, 2012 Accepting new patients
Asa Staffing Inc Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2017 Accepting new patients
Henry Ford Health Rochester Hospital CurrentSince Jan 1, 2021 Accepting new patients
Henry Ford Health Rochester Hospital Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2021 Accepting new patients
Nsa Pain Services of Michigan III, PLLC CurrentSince Sep 21, 2021 Accepting new patients
Henry Ford Macomb Hospital Corporation Nurse Anesthetist, Certified Registered CurrentSince Jan 5, 2012 Accepting new patients
Rochester Pathology PC Current Accepting new patients
Northstar Anesthesia of Michigan III PLLC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2021 Accepting new patients

Locations

7560 Solutions Ctr
Chicago, IL 60677

15855 19 Mile Rd
Clinton Twp, MI 48038
Phone (586) 263-2373

50 N Perry St
Pontiac, MI 48342
Phone (248) 338-5300

1101 W University Dr
Rochester Hls, MI 48307
Phone (248) 601-4805

3601 W 13 Mile Rd
Royal Oak, MI 48073

10000 Telegraph Rd
Taylor, MI 48180
Phone (313) 295-5000

33155 Annapolis St
Wayne, MI 48184
Phone (734) 467-4000

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/8209/brand/5/csg/21/fhir/r4

Organizations & group practices 8

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 2

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": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340668800000",
    "number": "1093868234",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5717 CANNES DR",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483141342"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 WEST UNIVERSITY DRIVE",
            "address_2": "CRITTENTON HOSPITAL MEDICAL CENTER",
            "city": "ROCHESTER",
            "state": "MI",
            "postal_code": "483071863",
            "telephone_number": "248-652-5354",
            "fax_number": "248-652-5861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DZIALO",
        "first_name": "DONNA",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2012-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704210409",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11909797",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4368763",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "430F364550",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rochester, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2012; 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.