Active NPI
Gordon Vittone, CRNA
- Certified Registered Nurse Anesthetist
- Wausau, WI
National Provider Identifier
1568480010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 4565830
- Practice address
- 425 Pine Ridge Blvd
Suite 211
Wausau, WI 54401-4123 - Phone
- (715) 845-5505
- Fax
- (715) 848-2884
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 4565830 | WI | Primary |
Addresses
Primary practice location
425 Pine Ridge Blvd
Suite 211
Wausau, WI 54401-4123
Mailing address
425 Pine Ridge Blvd
Suite 211
Wausau, WI 54401-4123
Phone (715) 845-5505
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 29700 | Other | WI | SECURITY HEALTH MEDICAID |
| 29700 | Other | WI | SECURITY HEALTH PLAN |
| 43274000 | Medicaid | WI | |
| VITTONE | Other | WI | WPS |
| 43274000 | Other | WI | MANAGED HEALTH CARE |
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
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4565830 | WI | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1568480010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "425 PINE RIDGE BLVD",
"address_2": "SUITE 211",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544014123",
"telephone_number": "715-845-5505",
"fax_number": "715-848-2884"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "425 PINE RIDGE BLVD",
"address_2": "SUITE 211",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544014123",
"telephone_number": "715-845-5505",
"fax_number": "715-848-2884"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VITTONE",
"first_name": "GORDON",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "WI",
"license": "4565830",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SECURITY HEALTH MEDICAID",
"identifier": "29700",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SECURITY HEALTH PLAN",
"identifier": "29700",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43274000",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WPS",
"identifier": "VITTONE",
"state": "WI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MANAGED HEALTH CARE",
"identifier": "43274000",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wausau, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.