Individual provider Active NPI

Gregory P Humbracht, CRNA

  • Certified Registered Nurse Anesthetist
  • Grass Lake, MI
National Provider Identifier
1124129374
Registry record updated Dec 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704115485 Issued in MI
Practice address
2980 Sarossy LK
Grass Lake, MI 49240-9455
Phone
(269) 251-2117
NPI assigned
Sep 26, 2006
Last updated
Dec 1, 2016By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 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 4704115485 MI Primary

Addresses

Primary practice location

2980 Sarossy LK
Grass Lake, MI 49240-9455

Mailing address

2980 Sarossy LK
Grass Lake, MI 49240-9455
Phone (269) 251-2117

Other identifiers 1

IdentifierTypeStateIssuer
4635722MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040130001022 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 5294638250 Reassigns benefits to 3 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Asa Staffing Inc Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2019 Accepting new patients
Northstar Anesthesia of Michigan II PC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2017 Accepting new patients
Essential Anesthesia Services, PLC Nurse Anesthetist, Certified Registered CurrentSince May 9, 2012 Accepting new patients
Sparrow Carson Hospital Nurse Anesthetist, Certified Registered Past Accepting new patients
Northeast Anesthesia Partners, Inc. Past Accepting new patients
Beaufort County Memorial Hospital Nurse Anesthetist, Certified Registered Past Accepting new patients
Beaufort County Memorial Hospital Past Accepting new patients
Mymichigan Medical Center Tawas Past Accepting new patients

Locations

1900 Columbus Ave
Bay City, MI 48708
Phone (989) 894-3000

748 S Main St
Cheboygan, MI 49721
Phone (231) 627-5601

274 E Chicago St
Coldwater, MI 49036
Phone (517) 279-5400

2775 Blake Rd
Jackson, MI 49201
Phone (517) 787-2906

1707 Lake Lansing Rd
Lansing, MI 48912
Phone (517) 267-0033

26750 Providence Pkwy
Ste 100
Novi, MI 48374
Phone (248) 662-1500

264 W Maple Rd
Ste 100
Troy, MI 48084
Phone (248) 269-5594

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.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480550400000",
    "number": "1124129374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2980 SAROSSY LK",
            "city": "GRASS LAKE",
            "state": "MI",
            "postal_code": "492409455",
            "telephone_number": "269-251-2117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2980 SAROSSY LK",
            "city": "GRASS LAKE",
            "state": "MI",
            "postal_code": "492409455",
            "telephone_number": "269-251-2117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMBRACHT",
        "first_name": "GREGORY",
        "middle_name": "P",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2016-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704115485",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4635722",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grass Lake, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.