NPIMap

Individual provider Active NPI

Kyle Michael Anderson, CRNA

  • Certified Registered Nurse Anesthetist
  • Green Bay, WI
National Provider Identifier
1205580313
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
162603 Issued in WI
Practice address
744 S Webster Ave
Green Bay, WI 54301-3505
Phone
(715) 495-4001
NPI assigned
Feb 8, 2022
Last updated
Aug 7, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

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 848576 NV
Certified Registered Nurse Anesthetist 367500000X 162603 WI Primary

Addresses

Primary practice location

744 S Webster Ave
Green Bay, WI 54301-3505

Mailing address

PO Box 840857
Dallas, TX 75284-0857
Phone (725) 204-4632

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, PA, MN3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20240113000671 WI Practitioner - Certified Registered Nurse Anesthetist (Crna) 1052706082 Reassigns benefits to 3 organizations
I20241230001624 PA Practitioner - Certified Registered Nurse Anesthetist (Crna) 1052706082 Reassigns benefits to 2 organizations
I20260331003522 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 1052706082 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians
Bellin Memorial Hospital IncGroup PAC ID 8820900749, 685 clinicians

Practice addresses (Care Compare)

111 S Front St
Harrisburg, PA 17101-2010
Phone (717) 782-3282

1836 S Ave
La Crosse, WI 54601-5429
Phone (608) 783-7300

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (651) 262-7633

744 S Webster Ave
Green Bay, WI 54301-3505
Phone (920) 433-6025

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
848576NVMDCertified Registered Nurse Anesthetist
162603WIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Bellin Memorial Hospital Inc Nurse Anesthetist, Certified Registered CurrentSince Aug 7, 2024 Accepting new patients
Gundersen Lutheran Medical Center Inc CurrentSince Jan 15, 2024 Accepting new patients
Oconto Hospital & Medical Center Inc CurrentSince Aug 7, 2024 Accepting new patients
Oconto Hospital & Medical Center, Inc. CurrentSince Aug 7, 2024 Accepting new patients
Gundersen Lutheran Medical Center Inc Current Accepting new patients
Oconto Hospital & Medical Center Inc Current Accepting new patients
Bellin Memorial Hospital Inc Current Accepting new patients
Upmc Pinnacle Anesthesia Services, LLC CurrentSince Aug 1, 2025 Accepting new patients
Gundersen Lutheran Medical Center, Inc CurrentSince Jan 15, 2024 Accepting new patients
Bellin Memorial Hospital Inc. CurrentSince Aug 7, 2024 Accepting new patients
St Vincent Medical Education and Research Institute Inc CurrentSince Oct 20, 2024 Accepting new patients
Upmc Pinnacle Anesthesia Services, LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2025 Accepting new patients
Arizona Anesthesia Consultants, Inc. Nurse Anesthetist, Certified Registered PastSince Feb 1, 2022 Accepting new patients

Locations

155 E State St
Albion, PA 16401
Phone (814) 756-4917

232 W 25th St
Erie, PA 16544
Phone (814) 452-5337

111 S Front St
Harrisburg, PA 17101
Phone (717) 782-3282

744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025

933 Waube Ln
Green Bay, WI 54304
Phone (920) 548-9500

1836 South Ave
La Crosse, WI 54601
Phone (608) 788-8102

1910 South Ave
La Crosse, WI 54601
Phone (608) 775-2287

2820 Roosevelt Rd
Marinette, WI 54143
Phone (715) 330-6171

820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100

Interoperability endpoints

  • Direct secure messaging: kanderson859425@direct.emplifyhealth.org

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 38

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 38

NPI Registry JSON

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

{
    "created_epoch": "1644278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722988800000",
    "number": "1205580313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840857",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752840857",
            "telephone_number": "725-204-4632",
            "fax_number": "702-805-0307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "744 S WEBSTER AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013505",
            "telephone_number": "715-495-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KYLE",
        "middle_name": "MICHAEL",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-02-08",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NV",
            "license": "848576",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "162603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; 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.