Active NPI
Mary Kay Bickmann, CRNA
- Certified Registered Nurse Anesthetist
- Leesburg, VA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 0024170746
- Practice address
- 44045 Riverside Pkwy
Leesburg, VA 20176-5101 - Phone
- (703) 858-6000
- NPI assigned
- Feb 28, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 4704153665 | MI | |
| Certified Registered Nurse Anesthetist | 367500000X | 0024170746 | VA | Primary |
Addresses
Primary practice location
44045 Riverside Pkwy
Leesburg, VA 20176-5101
Mailing address
3100 Spring Forest Rd
Suite 130
Raleigh, NC 27616-2880
Phone (919) 882-0705
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 430F373940 | Other | MI | BCBSM |
| 3284918 | Medicaid | MI | |
| 1366418394 | Medicaid | VA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704153665 | MI | MD | Certified Registered Nurse Anesthetist |
| 0024170746 | VA | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Munson Medical Center | Current | Accepting new patients | |
| William Beaumont Hospital | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| William Beaumont Hospital | Current | Accepting new patients | |
| Munson Medical Group | Current | Accepting new patients | |
| Munson Medical Group | Current | Accepting new patients | |
| Northstar Anesthesia of Michigan III PLLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Munson Medical Center | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Munson Medical Group | Current | Accepting new patients | |
| Beaumont Macomb Township ASC, LLC | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
Locations
2891 Momentum Pl
Chicago, IL 60689
825 N Center Ave
Gaylord, MI 49735
Phone (989) 731-2100
829 N Center Ave
Ste 210
Gaylord, MI 49735
Phone (989) 731-7860
15979 Hall Rd
Ste 200
Macomb, MI 48044
Phone (586) 247-5300
3601 W 13 Mile Rd
Royal Oak, MI 48073
4100 Park Forest Dr
Traverse City, MI 49684
Phone (231) 392-8900
1200 Sixth St
Ste 200
Traverse City, MI 49684
1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000
1105 Sixth St
Ste 103
Traverse City, MI 49684
Phone (231) 935-6455
130 Town Center Dr
Ste 203
Troy, MI 48084
Phone (248) 585-8250
44201 Dequindre Rd
Troy, MI 48085
Phone (248) 471-8255
33155 Annapolis St
Wayne, MI 48184
Phone (734) 467-4042
Organizations & group practices 9
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.
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- NPI 1184746463
Nurse Anesthetist, Certified Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141084800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1386201600000",
"number": "1366418394",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 SPRING FOREST RD",
"address_2": "SUITE 130",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276162880",
"telephone_number": "919-882-0705",
"fax_number": "919-873-9821"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "44045 RIVERSIDE PKWY",
"city": "LEESBURG",
"state": "VA",
"postal_code": "201765101",
"telephone_number": "703-858-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BICKMANN",
"first_name": "MARY",
"middle_name": "KAY",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-28",
"last_updated": "2013-12-05",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MI",
"license": "4704153665",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "VA",
"license": "0024170746",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSM",
"identifier": "430F373940",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3284918",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1366418394",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Leesburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2013; 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.