NPIMap

Organization Active NPI

Celebrity Anesthesia Staffing LLC

Doing business as Celebrity Anesthesia

  • Anesthesiology Physician
  • Grand Rapids, MI
National Provider Identifier
1235728403
Registry record updated Jan 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
CELEBRITY ANESTHESIA STAFFING LLC
Doing business as
Celebrity Anesthesia
Practice address
1179 E Paris Ave SE Ste E200
Grand Rapids, MI 49546-8371
Phone
(616) 975-9100
NPI assigned
Jan 13, 2021
Last updated
Jan 15, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Alex Kolascz, CRNANPI 1225416563
Title
Partner
Phone
(512) 593-1945

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

1179 E Paris Ave SE Ste E200
Grand Rapids, MI 49546-8371

Mailing address

3809 Valley View Rd BLDG 5
Austin, TX 78704-3375
Phone (512) 593-1945

Other names 1

  • Celebrity Anesthesia Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210204001005 MI Part B Supplier - Clinic/Group Practice 3678987534 Receives reassigned benefits from 42 practitioners
Practice locations: Lexington, MI

National Provider Directory

National Provider Directory

Locations

1179 East Paris Ave SE
Ste E200
Grand Rapids, MI 49546
Phone (616) 975-9100

Practitioners & affiliated clinicians

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1610496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1610668800000",
    "number": "1235728403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3809 VALLEY VIEW RD BLDG 5",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787043375",
            "telephone_number": "512-593-1945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1179 E PARIS AVE SE STE E200",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495468371",
            "telephone_number": "616-975-9100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CELEBRITY ANESTHESIA STAFFING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-13",
        "last_updated": "2021-01-15",
        "certification_date": "2021-01-15",
        "status": "A",
        "authorized_official_last_name": "KOLASCZ",
        "authorized_official_first_name": "ALEX",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "512-593-1945",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Celebrity Anesthesia",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Celebrity Anesthesia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2021; 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.