Active NPI
Thomas H Moular, CRNA
- Certified Registered Nurse Anesthetist
- Greenville, MI
National Provider Identifier
1588694152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 4704072410
- Practice address
- 615 S Bower St
Greenville, MI 48838-2614 - Phone
- (616) 754-4691
- NPI assigned
- Jul 3, 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 | 4704072410 | MI | Primary |
Addresses
Primary practice location
615 S Bower St
Greenville, MI 48838-2614
Mailing address
615 S Bower St
Greenville, MI 48838-2614
Phone (616) 754-4691
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4465435 | Medicaid | MI | |
| 4594432 | Medicaid | MI |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704072410 | MI | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1151884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1588694152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "615 S BOWER ST",
"city": "GREENVILLE",
"state": "MI",
"postal_code": "488382614",
"telephone_number": "616-754-4691"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "615 S BOWER ST",
"city": "GREENVILLE",
"state": "MI",
"postal_code": "488382614",
"telephone_number": "616-754-4691"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOULAR",
"first_name": "THOMAS",
"middle_name": "H",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MI",
"license": "4704072410",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4465435",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4594432",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greenville, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.