Individual provider Active NPI

Nicole Marie Pickersgill, CRNA

  • Certified Registered Nurse Anesthetist
  • Detroit, MI
National Provider Identifier
1508197534
Registry record updated Sep 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704233491 Issued in MI
Practice address
2799 W Grand Blvd
Detroit, MI 48202-2608
Phone
(313) 874-6256
NPI assigned
Jan 14, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2010

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 4704233491 MI Primary

Addresses

Primary practice location

2799 W Grand Blvd
Detroit, MI 48202-2608

Mailing address

3037 Rockwell Blvd
Windsor, ONTARIO N9E 2A6
CA
Phone (519) 972-0063

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100514000888 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 7911035795 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2009
Medicare assignment
May accept Medicare assignment
Group practices
Northstar Anesthesia of Michigan III PLLCGroup PAC ID 7911325469, 561 clinicians

Practice addresses (Care Compare)

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

Hospital & facility affiliations

  • Beaumont Hospital - Taylor Hospital, Taylor, MI, CCN 230270
  • Beaumont Hospital - Dearborn Hospital, Dearborn, MI, CCN 230020

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704233491MIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of Michigan III PLLC Nurse Anesthetist, Certified Registered CurrentSince Aug 20, 2020 Accepting new patients
Henry Ford Health System CurrentSince Feb 28, 2010 Accepting new patients
Henry Ford Health System Nurse Anesthetist, Certified Registered CurrentSince Feb 28, 2010 Accepting new patients

Locations

1 William Carls Dr
Commerce Twp, MI 48382
Phone (248) 227-5500

18101 Oakwood Blvd
Dearborn, MI 48124
Phone (313) 593-8780

1 Ford Pl
Ste 2E
Detroit, MI 48202
Phone (313) 874-3953

2799 W Grand Blvd
Detroit, MI 48202
Phone (313) 876-2062

10000 Telegraph Rd
Taylor, MI 48180
Phone (313) 295-5000

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": "1263427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1285804800000",
    "number": "1508197534",
    "addresses": [
        {
            "country_code": "CA",
            "country_name": "Canada",
            "address_purpose": "MAILING",
            "address_type": "FGN",
            "address_1": "3037 ROCKWELL BLVD",
            "city": "WINDSOR",
            "state": "ONTARIO",
            "postal_code": "N9E 2A6",
            "telephone_number": "519-972-0063"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2799 W GRAND BLVD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482022608",
            "telephone_number": "313-874-6256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PICKERSGILL",
        "first_name": "NICOLE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-01-14",
        "last_updated": "2010-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704233491",
            "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 Sep 30, 2010; 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.