Active NPI
Adam Joseph Perissinotti, CRNA
- Certified Registered Nurse Anesthetist
- Detroit, MI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 4704285098
- Practice address
- 4201 Saint Antoine St
Detroit, MI 48201-2153 - Phone
- (313) 745-3330
- NPI assigned
- Mar 9, 2017
- 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 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 200965-6 | MN | |
| Registered Nurse | 163W00000X | 4704285098 | MI | |
| Registered Nurse | 163W00000X | RN1033014 | DC | |
| Certified Registered Nurse Anesthetist | 367500000X | 4704285098 | MI | Primary |
Addresses
Primary practice location
4201 Saint Antoine St
Detroit, MI 48201-2153
Mailing address
1212 Carriage Lane
Lasalle, ONTARIO N9H 1Z8
CA
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2016
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4201 Saint Antoine St
Detroit, MI 48201-2153
Phone (313) 745-3615
Hospital & facility affiliations
- Detroit Receiving Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN1033014 | DC | MD | Registered Nurse |
| 4704285098 | MI | MD | Registered Nurse |
| 200965-6 | MN | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northstar Anesthesia of Michigan III PLLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Northstar Anesthesia of Michigan PLLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
Locations
4201 Saint Antoine St
Detroit, MI 48201
Phone (313) 745-3615
3601 W 13 Mile Rd
Royal Oak, MI 48073
33155 Annapolis St
Wayne, MI 48184
Phone (734) 467-4042
6225 State Highway 161
Ste 200
Irving, TX 75038
Phone (214) 687-0496
Organizations & group practices 2
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.
-
- Anesthesiology Physician
- Irving, TX
- NPI 1871986372
MI, Nurse Anesthetist, Certified Registered
-
- Pain Medicine (Anesthesiology) Physician
- Irving, TX
- NPI 1972126209
MI, Nurse Anesthetist, Certified Registered
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Detroit, MI
- NPI 1619289998
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489017600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683676800000",
"number": "1316488422",
"addresses": [
{
"country_code": "CA",
"country_name": "Canada",
"address_purpose": "MAILING",
"address_type": "FGN",
"address_1": "1212 CARRIAGE LANE",
"city": "LASALLE",
"state": "ONTARIO",
"postal_code": "N9H 1Z8"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4201 SAINT ANTOINE ST",
"city": "DETROIT",
"state": "MI",
"postal_code": "482012153",
"telephone_number": "313-745-3330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERISSINOTTI",
"first_name": "ADAM",
"middle_name": "JOSEPH",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-03-09",
"last_updated": "2023-05-10",
"certification_date": "2023-05-10",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MN",
"license": "200965-6",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MI",
"license": "4704285098",
"primary": false
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "DC",
"license": "RN1033014",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MI",
"license": "4704285098",
"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 May 10, 2023; 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.