NPIMap

Organization Active NPI

Northern Anesthesia Providers PC

  • Anesthesiology Physician
  • Petoskey, MI
National Provider Identifier
1396834628
Registry record updated Jul 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
NORTHERN ANESTHESIA PROVIDERS PC
Practice address
602 Jackson St
Petoskey, MI 49770-2220
Phone
(231) 348-2795
Fax
(231) 348-2031
NPI assigned
Oct 12, 2006
Last updated
Jul 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2025

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

Authorized official

Name
Mytch Vanderlooven
Title
Office Manager
Phone
(231) 348-2795

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X Primary

Addresses

Primary practice location

602 Jackson St
Petoskey, MI 49770-2220

Mailing address

602 Jackson St
Petoskey, MI 49770-2220
Phone (231) 348-2795

Other identifiers 1

IdentifierTypeStateIssuer
0B46025OtherBLUE CROSS BLUE SHIELD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040218000105 MI Part B Supplier - Clinic/Group Practice 4789579863 Receives reassigned benefits from 38 practitioners
Practice locations: Petoskey, MI
O20060405000243 MI Part B Supplier - Clinic/Group Practice 4789579863 Receives reassigned benefits from 18 practitioners
Practice locations: Cheboygan, MI; Petoskey, MI

National Provider Directory

National Provider Directory

Locations

602 Jackson St
Petoskey, MI 49770
Phone (231) 348-2795

Practitioners & affiliated clinicians

Practitioners 68

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 68

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1752192000000",
    "number": "1396834628",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "602 JACKSON ST",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702220",
            "telephone_number": "231-348-2795",
            "fax_number": "231-348-2031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 JACKSON ST",
            "city": "PETOSKEY",
            "state": "MI",
            "postal_code": "497702220",
            "telephone_number": "231-348-2795",
            "fax_number": "231-348-2031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN ANESTHESIA PROVIDERS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2025-07-11",
        "certification_date": "2025-07-11",
        "status": "A",
        "authorized_official_last_name": "VANDERLOOVEN",
        "authorized_official_first_name": "MYTCH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "231-348-2795"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "0B46025",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Petoskey, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2025; 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.