Individual provider Active NPI

Troy Alan Broka

  • Certified Registered Nurse Anesthetist
  • Lansing, MI
National Provider Identifier
1396876876
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704190455 Issued in MI
Practice address
401 W Greenlawn Ave
Lansing, MI 48910-2819
Phone
(517) 377-8225
Fax
(517) 372-5006
NPI assigned
Mar 8, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 4704190455 MI Primary

Addresses

Primary practice location

401 W Greenlawn Ave
Lansing, MI 48910-2819

Mailing address

401 W Greenlawn Ave
Lansing, MI 48910-2819
Phone (517) 377-8225

Other identifiers 1

IdentifierTypeStateIssuer
4704190455OtherMISTATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080917000380 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 5496822421 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sparrow Eaton HospitalGroup PAC ID 0042103509, shared by 4 NPIs, 45 clinicians

Practice addresses (Care Compare)

321 E Harris St
Charlotte, MI 48813-1629
Phone (517) 543-1050

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704190455MIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Sparrow Eaton Hospital Current Accepting new patients
Sparrow Eaton Hospital CurrentSince Jul 1, 2008 Accepting new patients
Sparrow Carson Hospital CurrentSince Jul 15, 2021 Accepting new patients
Sparrow Eaton Hospital Nurse Anesthetist, Certified Registered CurrentSince Apr 21, 2020 Accepting new patients
Sparrow Carson Hospital Nurse Anesthetist, Certified Registered CurrentSince Jul 15, 2021 Accepting new patients
Capital Area Anesthesia PC Nurse Anesthetist, Certified Registered CurrentSince Jul 5, 2013 Accepting new patients
Sparrow Carson Hospital Current Accepting new patients
Sparrow Eaton Hospital CurrentSince Jul 1, 2008 Accepting new patients

Locations

8175 Reliable Pkwy
Chicago, IL 60686

406 E Elm St
Carson City, MI 48811
Phone (517) 584-3131

111 Lansing St
Ste 110
Charlotte, MI 48813
Phone (517) 541-5855

123 Lansing St
Ste 2
Charlotte, MI 48813
Phone (517) 541-5954

321 E Harris St
Charlotte, MI 48813
Phone (517) 541-5840

321 E Harris St
Ste C
Charlotte, MI 48813

2727 S Pennsylvania Ave
Lansing, MI 48910
Phone (517) 975-3750

2900 Collins Rd
Lansing, MI 48910
Phone (517) 975-7500

401 W Greenlawn Ave
Lansing, MI 48910
Phone (517) 334-2286

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1396876876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 W GREENLAWN AVE",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489102819",
            "telephone_number": "517-377-8225",
            "fax_number": "517-372-5006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 W GREENLAWN AVE",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489102819",
            "telephone_number": "517-377-8225",
            "fax_number": "517-372-5006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROKA",
        "first_name": "TROY",
        "middle_name": "ALAN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704190455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "4704190455",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lansing, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.