Individual provider Active NPI

Patricia Lynn Koprivica, CRNA

  • Certified Registered Nurse Anesthetist
  • Jackson, MI
National Provider Identifier
1194843110
Registry record updated Mar 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704170848 Issued in MI
Practice address
5919 Amber
Jackson, MI 49201-8389
Phone
(517) 783-5494
Fax
(517) 783-5494
NPI assigned
Mar 27, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 30, 2021

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 4704170848 MI Primary

Addresses

Primary practice location

5919 Amber
Jackson, MI 49201-8389

Mailing address

5919 Amber
Jackson, MI 49201-8389
Phone (517) 783-5494

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address pkoprivica453110@direct.hfhs.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040306000173 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 1254229727 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
W. a. Foote Memorial Hospital, Inc.Group PAC ID 0244136067, 476 clinicians

Practice addresses (Care Compare)

205 N E Ave
Jackson, MI 49201-1753

205 S E Ave
Henry Ford Allegiance Digestive HLT
Jackson, MI 49201-2413
Phone (517) 205-2103

Hospital & facility affiliations

  • Henry Ford Allegiance Health Hospital, Jackson, MI, CCN 230092

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Wa Foote Memorial Hospital, Inc Nurse Anesthetist, Certified Registered CurrentSince Jul 30, 2003 Accepting new patients
Chelsea Community Hospital Nurse Anesthetist, Certified Registered CurrentSince Aug 11, 2012 Accepting new patients
W.a. Foote Memorial Hospital, Inc CurrentSince Jul 30, 2003 Accepting new patients
Chelsea Community Hospital CurrentSince Aug 11, 2012 Accepting new patients

Locations

775 S Main St
Chelsea, MI 48118
Phone (313) 995-3764

205 S East Ave
Jackson, MI 49201
Phone (517) 205-2103

205 N East Ave
Jackson, MI 49201
Phone (517) 788-4730

Interoperability endpoints

  • Direct secure messaging: pkoprivica453110@direct.hfhs.org

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 1

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": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617062400000",
    "number": "1194843110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5919 AMBER",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492018389",
            "telephone_number": "517-783-5494",
            "fax_number": "517-783-5494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5919 AMBER",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492018389",
            "telephone_number": "517-783-5494",
            "fax_number": "517-783-5494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOPRIVICA",
        "first_name": "PATRICIA",
        "middle_name": "LYNN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-27",
        "last_updated": "2021-03-30",
        "certification_date": "2021-03-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704170848",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "pkoprivica453110@direct.hfhs.org",
            "affiliation": "N",
            "address_1": "205 N East Ave",
            "city": "Jackson",
            "state": "MI",
            "country_code": "US",
            "postal_code": "492011753",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2021; 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.