Individual provider Active NPI

Michael Flamisch, CRNA

  • Registered Nurse
  • Mount Holly, NJ
National Provider Identifier
1316189509
Registry record updated Oct 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
26NO11609300 Issued in NJ
Practice address
175 Madison Ave
Mount Holly, NJ 08060-2038
Phone
(609) 267-0700
NPI assigned
Apr 2, 2009
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 5, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 26NO11609300 NJ Primary

Addresses

Primary practice location

175 Madison Ave
Mount Holly, NJ 08060-2038

Mailing address

PO Box 95000-2130
Philadelphia, PA 19195-0001
Phone (201) 804-2800

Other identifiers 1

IdentifierTypeStateIssuer
26NO11609300OtherNJSTATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090903000499 NJ Practitioner - Certified Registered Nurse Anesthetist (Crna) 3779638390 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Society Hill Anesthesia Consultants of New Jersey, PCGroup PAC ID 9133150063, 18 clinicians

Practice addresses (Care Compare)

408 Route 70 E
Wills Eye Surgery Center in Cherry
Cherry Hill, NJ 08034
Phone (856) 354-1600

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26NO11609300NJMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Society Hill Anesthesia Consultants of New Jersey, PC CurrentSince Dec 1, 2020 Accepting new patients
Professional Service Fund of Deborah Heart & Lung Center Current Accepting new patients
Professional Service Fund of Deborah- Anesthesia CurrentSince Jan 13, 2020 Accepting new patients
Society Hill Anesthesia Consultants, PC Past Accepting new patients

Locations

200 Trenton Rd
Browns Mills, NJ 08015
Phone (609) 893-1200

408 Route 70 E
Cherry Hill, NJ 08034
Phone (267) 322-7700

140 Mount Holly by Pass
Ste 5
Lumberton, NJ 08048
Phone (609) 267-1555

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": "1238630400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601856000000",
    "number": "1316189509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 95000-2130",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191950001",
            "telephone_number": "201-804-2800",
            "fax_number": "201-804-8883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 MADISON AVE",
            "city": "MOUNT HOLLY",
            "state": "NJ",
            "postal_code": "080602038",
            "telephone_number": "609-267-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FLAMISCH",
        "first_name": "MICHAEL",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-04-02",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NJ",
            "license": "26NO11609300",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "26NO11609300",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Holly, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2020; 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.