Individual provider Active NPI

Glenda M Calvin, CRNA

  • Certified Registered Nurse Anesthetist
  • Southfield, MI
National Provider Identifier
1275638157
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704136715 Issued in MI
Practice address
16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone
(248) 849-5806
Fax
(248) 849-5489
NPI assigned
Sep 14, 2006
Sex
Female
Sole proprietor
No

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 4704136715 MI Primary

Addresses

Primary practice location

16001 W 9 Mile Rd
Southfield, MI 48075-4818

Mailing address

16001 W 9 Mile Rd
Southfield, MI 48075-4818
Phone (248) 849-5806

Other identifiers 1

IdentifierTypeStateIssuer
1986724MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704136715MIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
PSJ Anesthesia PC Nurse Anesthetist, Certified Registered CurrentSince Jan 25, 2016 Accepting new patients

Locations

47601 Grand River Ave
Novi, MI 48374
Phone (248) 465-4100

16001 W 9 Mile Rd
Southfield, MI 48075
Phone (248) 424-3000

Organizations & group practices 1

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": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275638157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16001 W 9 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754818",
            "telephone_number": "248-849-5806",
            "fax_number": "248-849-5489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16001 W 9 MILE RD",
            "city": "SOUTHFIELD",
            "state": "MI",
            "postal_code": "480754818",
            "telephone_number": "248-849-5806",
            "fax_number": "248-849-5489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CALVIN",
        "first_name": "GLENDA",
        "middle_name": "M",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704136715",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1986724",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Southfield, 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.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.