Individual provider Active NPI

Nicole Thurman

  • Certified Registered Nurse Anesthetist
  • Detroit, MI
National Provider Identifier
1417620865
Registry record updated May 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704303617 Issued in MI
Practice address
15324 Vaughan St
Detroit, MI 48223-1753
Phone
(313) 549-1731
NPI assigned
Jul 30, 2021
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 19, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 4704303617 MI
Certified Registered Nurse Anesthetist 367500000X 4704303617 MI Primary

Addresses

Primary practice location

15324 Vaughan St
Detroit, MI 48223-1753

Mailing address

15324 Vaughan St
Detroit, MI 48223-1753
Phone (313) 549-1731

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220527000770 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 4981082203 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2022
Medicare assignment
May accept Medicare assignment
Group practices
Essential Anesthesia Services, PLCGroup PAC ID 0244492494, 17 clinicians
Northstar Anesthesia of Michigan III PLLCGroup PAC ID 7911325469, 561 clinicians

Practice addresses (Care Compare)

264 W Maple Rd
Suite 100
Troy, MI 48084-5458
Phone (248) 269-5594

33155 Annapolis St
Wayne, MI 48184-2405
Phone (214) 687-0001

3601 W 13 Mile Rd
Royal Oak, MI 48073-6712
Phone (214) 687-0001

Hospital & facility affiliations

  • Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704303617MIMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of Michigan III PLLC Nurse Anesthetist, Certified Registered CurrentSince Feb 2, 2023 Accepting new patients
Essential Anesthesia Services, PLC Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2025 Accepting new patients
Gastrointestinal Specialists PC CurrentSince Jul 1, 2025 Accepting new patients

Locations

264 W Maple Rd
Ste 100
Troy, MI 48084
Phone (248) 269-5594

264 W Maple Rd
Ste 200
Troy, MI 48084
Phone (248) 273-9930

33155 Annapolis St
Wayne, MI 48184
Phone (734) 467-4042

Organizations & group practices 3

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1627603200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684454400000",
    "number": "1417620865",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15324 VAUGHAN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482231753",
            "telephone_number": "313-549-1731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15324 VAUGHAN ST",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482231753",
            "telephone_number": "313-549-1731"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THURMAN",
        "first_name": "NICOLE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-30",
        "last_updated": "2023-05-19",
        "certification_date": "2023-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704303617",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704303617",
            "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 19, 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.

Verify at the official NPI Registry.