Individual provider Active NPI

Michael Gandy, CRNA

  • Certified Registered Nurse Anesthetist
  • Fort Wayne, IN
National Provider Identifier
1487477345
Registry record updated Jan 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
28278333A Issued in IN
Practice address
6435 W Jefferson Blvd # 434
Fort Wayne, IN 46804-6203
Phone
(260) 436-7875
Fax
(260) 732-9812
NPI assigned
Nov 7, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 6, 2025

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 51674 IN
Certified Registered Nurse Anesthetist 367500000X 28278333A IN Primary

Addresses

Primary practice location

6435 W Jefferson Blvd # 434
Fort Wayne, IN 46804-6203

Mailing address

PO Box 843603
Dallas, TX 75284-3603

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250107002557 IN Practitioner - Certified Registered Nurse Anesthetist (Crna) 0345778130 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Anesthesiologists of Fort Wayne PCGroup PAC ID 2264412444, 101 clinicians

Practice addresses (Care Compare)

7950 W Jefferson Blvd
Lutheran Hospital
Fort Wayne, IN 46804-4140
Phone (260) 435-7001

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
28278333AINMDCertified Registered Nurse Anesthetist
51674INMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Anesthesiologists of Fort Wayne PC Nurse Anesthetist, Certified Registered CurrentSince Jan 6, 2025 Accepting new patients
U S Anesthesia Partners of Kentucky PSC Nurse Anesthetist, Certified Registered PastSince Sep 1, 2023 Accepting new patients

Locations

1316 E 7th St
Auburn, IN 46706
Phone (260) 925-4600

7950 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 434-7088

10315 Dawsons Creek Blvd
Ste Ab
Fort Wayne, IN 46825
Phone (219) 436-7875

2520 E DuPont Rd
Fort Wayne, IN 46825
Phone (219) 407-8000

7952 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 435-2999

702 Van Buren St
Fort Wayne, IN 46802
Phone (260) 425-3000

6435 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 436-7875

2101 Dubois Dr
Warsaw, IN 46580
Phone (219) 267-3200

12222 Merit Dr
Ste 600
Dallas, TX 75251
Phone (972) 361-1844

Organizations & group practices 2

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 4

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": "1730937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736121600000",
    "number": "1487477345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 843603",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752843603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6435 W JEFFERSON BLVD # 434",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046203",
            "telephone_number": "260-436-7875",
            "fax_number": "260-732-9812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANDY",
        "first_name": "MICHAEL",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-11-07",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "51674",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "28278333A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; 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.