Individual provider Active NPI

Beth Ellen Ver Kuilen, CRNA

  • Certified Registered Nurse Anesthetist
  • Detroit, MI
National Provider Identifier
1255420949
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704163577 Issued in MI
Practice address
22101 Moross Rd
Detroit, MI 48236-2148
Phone
(313) 343-4766
NPI assigned
Oct 12, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 4704163577 MI Primary

Addresses

Primary practice location

22101 Moross Rd
Detroit, MI 48236-2148

Mailing address

255 Lewiston Rd
Grosse Pointe Farms, MI 48236-3450
Phone (313) 882-2451

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041214000881 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 8729045414 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704163577MIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital Nurse Anesthetist, Certified Registered CurrentSince Jan 12, 2004 Accepting new patients
Henry Ford Health St. John Hospital CurrentSince Jan 12, 2004 Accepting new patients
Waterford Anesthesia, PLLC CurrentSince May 20, 2016 Accepting new patients
Waterford Surgical Center, LLC Past Accepting new patients

Locations

7915 Solutions Ctr Dr
Chicago, IL 60677

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

1546 Callis Rd
Lapeer, MI 48446
Phone (810) 667-4000

5220 Highland Rd
Ste 100
Waterford, MI 48327
Phone (248) 461-2800

5220 Highland Rd
Ste 1
Waterford, MI 48327
Phone (248) 886-5555

Interoperability endpoints

  • Direct secure messaging: bverkuilen1156547@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.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1255420949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 LEWISTON RD",
            "city": "GROSSE POINTE FARMS",
            "state": "MI",
            "postal_code": "482363450",
            "telephone_number": "313-882-2451"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362148",
            "telephone_number": "313-343-4766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VER KUILEN",
        "first_name": "BETH",
        "middle_name": "ELLEN",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704163577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.