Individual provider Active NPI

Jerry L Frank, CRNA

  • Certified Registered Nurse Anesthetist
  • Ann Arbor, MI
National Provider Identifier
1487621470
Registry record updated Oct 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704139542 Issued in MI
Practice address
1500 East Medical Center Drive
1H247 University Hospital
Ann Arbor, MI 48109-5048
Phone
(734) 936-4280
Fax
(734) 936-9091
NPI assigned
Mar 8, 2006
Last updated
Oct 4, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2012

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 4704139542 MI Primary

Addresses

Primary practice location

1500 East Medical Center Drive
1H247 University Hospital
Ann Arbor, MI 48109-5048

Mailing address

3621 South State Street
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Other identifiers 2

IdentifierTypeStateIssuer
1603430MedicaidMI
430F364420OtherMIBCBSM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090813000305 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 4284788001 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704139542MIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Ambulatory Anesthesia Associates, PC Nurse Anesthetist, Certified Registered CurrentSince Jul 11, 2009 Accepting new patients
Blair County Anesthesia, P.C. Past Accepting new patients
West Shore Anesthesia Associates, LTD Past Accepting new patients
Beaumont West Bloomfield ASC LLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Lexington Anesthesia Associates, Inc. Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

230 W Maple Rd
Troy, MI 48084
Phone (248) 244-1500

Organizations & group practices 5

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": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349308800000",
    "number": "1487621470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 SOUTH STATE STREET",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 EAST MEDICAL CENTER DRIVE",
            "address_2": "1H247 UNIVERSITY HOSPITAL",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481095048",
            "telephone_number": "734-936-4280",
            "fax_number": "734-936-9091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FRANK",
        "first_name": "JERRY",
        "middle_name": "L",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2012-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704139542",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1603430",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "430F364420",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2012; 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.