Individual provider Active NPI

Vanessa J Peters, CRNA

  • Certified Registered Nurse Anesthetist
  • Dearborn, MI
National Provider Identifier
1104061613
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704228826 Issued in MI
Practice address
18101 Oakwood Blvd
Dearborn, MI 48124-4089
Phone
(313) 593-7000
NPI assigned
Dec 12, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

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 4704228826 MI Primary

Addresses

Primary practice location

18101 Oakwood Blvd
Dearborn, MI 48124-4089

Mailing address

18101 Oakwood Blvd
Dearborn, MI 48124-4089
Phone (313) 593-7000

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address vpeters92390@epicdirect.promedica.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090205000035 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 0749344844 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central Corporation of MichiganGroup PAC ID 7012902265, 112 clinicians

Practice addresses (Care Compare)

5640 N Adrian Hwy
Adrian, MI 49221-8318
Phone (419) 291-4491

Hospital & facility affiliations

  • Promedica Monroe Regional Hospital Hospital, Monroe, MI, CCN 230099

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Memorial Hospital Corporation CurrentSince Aug 3, 2014 Accepting new patients
Northstar Anesthesia of Michigan III PLLC Nurse Anesthetist, Certified Registered CurrentSince Aug 20, 2020 Accepting new patients
Promedica Central Corporation of Michigan CurrentSince Jun 6, 2023 Accepting new patients
Mercy Memorial Hospital Corporation Nurse Anesthetist, Certified Registered CurrentSince Aug 3, 2014 Accepting new patients

Locations

818 Riverside Ave
Adrian, MI 49221
Phone (517) 263-0711

5640 N Adrian Hwy
Adrian, MI 49221
Phone (419) 291-3000

18101 Oakwood Blvd
Dearborn, MI 48124
Phone (313) 593-8780

3175 Smith Rd
Lambertville, MI 48144
Phone (734) 856-5494

718 N Macomb St
Monroe, MI 48162
Phone (734) 212-3097

200 E Russell Rd
Unit C
Tecumseh, MI 49286
Phone (517) 424-3883

33155 Annapolis St
Wayne, MI 48184
Phone (734) 467-4042

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

Organizations & group practices 4

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.

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": "1229040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1104061613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18101 OAKWOOD BLVD",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481244089",
            "telephone_number": "313-593-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18101 OAKWOOD BLVD",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481244089",
            "telephone_number": "313-593-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "VANESSA",
        "middle_name": "J",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-12",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704228826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "vpeters92390@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Dearborn, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2023; 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.