Individual provider Active NPI

Mary Kay Bickmann, CRNA

  • Certified Registered Nurse Anesthetist
  • Leesburg, VA
National Provider Identifier
1366418394
Registry record updated Dec 5, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
0024170746 Issued in VA
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

Updated by the provider on Dec 5, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
430F373940OtherMIBCBSM
3284918MedicaidMI
1366418394MedicaidVA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081223000158 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 2264594464 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704153665MIMDCertified Registered Nurse Anesthetist
0024170746VAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Center CurrentSince Feb 1, 2025 Accepting new patients
William Beaumont Hospital Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 1989 Accepting new patients
William Beaumont Hospital CurrentSince Jan 1, 1989 Accepting new patients
Munson Medical Group Current Accepting new patients
Munson Medical Group CurrentSince Feb 25, 2024 Accepting new patients
Northstar Anesthesia of Michigan III PLLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2021 Accepting new patients
Munson Medical Center Nurse Anesthetist, Certified Registered CurrentSince Feb 1, 2025 Accepting new patients
Munson Medical Group CurrentSince Feb 25, 2024 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.

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.

Verify at the official NPI Registry.