Individual provider Active NPI

Ada Beth Kusnetz, M.D.

  • Anesthesiology Physician
  • Warren, MI
National Provider Identifier
1477589760
Registry record updated May 28, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
4301053043 Issued in MI
Practice address
21230 Dequindre Rd
Warren, MI 48091-2279
Phone
(586) 427-1000
NPI assigned
Jun 25, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 28, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 4301053043 MI Primary

Addresses

Primary practice location

21230 Dequindre Rd
Warren, MI 48091-2279

Mailing address

255 W Michigan Ave
Jackson, MI 49201-2218
Phone (517) 787-6440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
4301053043MIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lakes Anesthesia, PLC Anesthesiology Past Accepting new patients
Michigan Interventional Pain Associates PLLC Anesthesiology Past Accepting new patients
The Berry Center, LLC Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1151193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1211932800000",
    "number": "1477589760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W MICHIGAN AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012218",
            "telephone_number": "517-787-6440",
            "fax_number": "517-787-4146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21230 DEQUINDRE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480912279",
            "telephone_number": "586-427-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUSNETZ",
        "first_name": "ADA",
        "middle_name": "BETH",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-25",
        "last_updated": "2008-05-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MI",
            "license": "4301053043",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 28, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.