Individual provider Active NPI

Marissa J Hernandez, CRNA

  • Certified Registered Nurse Anesthetist
  • Wausau, WI
National Provider Identifier
1104164417
Registry record updated Aug 21, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
8629-33 Issued in WI
Practice address
411 Westwood Dr
Wausau, WI 54401
Phone
(715) 847-2558
Fax
(715) 847-2557
NPI assigned
Jan 21, 2013
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2018

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 0001241907 VA
Certified Registered Nurse Anesthetist 367500000X 8629-33 WI Primary

Addresses

Primary practice location

411 Westwood Dr
Wausau, WI 54401

Mailing address

411 Westwood Dr
Wausau, WI 54401-4152
Phone (715) 847-2558

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180915000000 WI Practitioner - Certified Registered Nurse Anesthetist (Crna) 7012152838 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Alliance Services LLCGroup PAC ID 9234477092, 13 clinicians
Gastrointestinal Associates S.C.Group PAC ID 4385677814, 42 clinicians

Practice addresses (Care Compare)

140 24TH St S
Wisconsin Rapids, WI 54494-1906
Phone (715) 424-1881

411 Westwood Dr
Wausau, WI 54401-4152
Phone (715) 847-2558

Merit-based Incentive Payment System (MIPS)

Final score
90.86 of 100Reported as group
Quality
86.95
Promoting interoperability
100

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0001241907VAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Alliance Services LLC Nurse Anesthetist, Certified Registered CurrentSince May 29, 2019 Accepting new patients
Marshfield Clinic Inc CurrentSince Sep 10, 2018 Accepting new patients
Gastrointestinal Associates S.C. CurrentSince Oct 1, 2018 Accepting new patients

Locations

1000 Starr Ave
Eau Claire, WI 54703
Phone (715) 858-4850

3501 Golf Rd
Eau Claire, WI 54701
Phone (715) 858-4200

1000 N Oak Ave
Marshfield, WI 54449
Phone (715) 387-5111

1001 W Glen Oaks Ln
Ste 105
Mequon, WI 53092
Phone (414) 258-8314

3301 Stanley St
Stevens Point, WI 54481
Phone (715) 268-5500

411 Westwood Dr
Wausau, WI 54401
Phone (715) 479-0374

800 N 1st St
#100
Wausau, WI 54403
Phone (715) 261-8500

2727 Plaza Dr
Wausau, WI 54401
Phone (715) 847-3000

800 N 1st St
Wausau, WI 54403
Phone (715) 261-8500

140 24th St S
Wisconsin Rapids, WI 54494
Phone (715) 424-1881

Organizations & group practices 3

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": "1358726400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534809600000",
    "number": "1104164417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "411 WESTWOOD DR",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544014152",
            "telephone_number": "715-847-2558",
            "fax_number": "715-847-2557"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 WESTWOOD DR",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "54401",
            "telephone_number": "715-847-2558",
            "fax_number": "715-847-2557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "MARISSA",
        "middle_name": "J",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-01-21",
        "last_updated": "2018-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0001241907",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "8629-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2018; 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.