Active NPI
Thomas J. Wigton, CRNA
- Certified Registered Nurse Anesthetist
- Traverse City, MI
National Provider Identifier
1295720894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 4704185255
- Practice address
- 4100 Park Forest Dr
Suite 210
Traverse City, MI 49684-7331 - Phone
- (231) 935-5770
- Fax
- (231) 935-0747
- NPI assigned
- Sep 20, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 4704185255 | MI | Primary |
Addresses
Primary practice location
4100 Park Forest Dr
Suite 210
Traverse City, MI 49684-7331
Mailing address
4100 Park Forest Dr
Suite 210
Traverse City, MI 49684-7331
Phone (231) 935-5770
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 430048952 | Other | MI | MEDICARE RAIL ROAD TSC |
| 1295720894 | Medicaid | MI | |
| 430B810310 | Other | MI | BCBS TSC |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 4704185255 | MI | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mymichigan Medical Center Tawas | Past | Accepting new patients |
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.
-
- Rural Health Clinic/Center
- Tawas City, MI
- NPI 1952399743
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127174400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1429056000000",
"number": "1295720894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4100 PARK FOREST DR",
"address_2": "SUITE 210",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496847331",
"telephone_number": "231-935-5770",
"fax_number": "231-935-0747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4100 PARK FOREST DR",
"address_2": "SUITE 210",
"city": "TRAVERSE CITY",
"state": "MI",
"postal_code": "496847331",
"telephone_number": "231-935-5770",
"fax_number": "231-935-0747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIGTON",
"first_name": "THOMAS",
"middle_name": "J.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-20",
"last_updated": "2015-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MI",
"license": "4704185255",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAIL ROAD TSC",
"identifier": "430048952",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1295720894",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS TSC",
"identifier": "430B810310",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Traverse City, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.