Individual provider Active NPI

Keith Leonard Michon, CRNA

  • Certified Registered Nurse Anesthetist
  • San Diego, CA
National Provider Identifier
1619934411
Registry record updated Jul 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
074376 Issued in CA
Practice address
34800 Bob Wilson Dr
Nmcsd, Attn: Medical Staff Services
San Diego, CA 92134-1098
Phone
(619) 532-6460
Fax
(619) 532-6299
NPI assigned
Apr 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 26, 2007

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 074376 CA Primary

Addresses

Primary practice location

34800 Bob Wilson Dr
Nmcsd, Attn: Medical Staff Services
San Diego, CA 92134-1098

Mailing address

34800 Bob Wilson Dr
Nmcsd, Attn: Medical Staff Services
San Diego, CA 92134-1098
Phone (619) 532-6460

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071102000210 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 6103913462 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

5300 Elliott Dr
Ypsilanti, MI 48197-8632
Phone (734) 434-6262

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
074376CAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Huron Gastroenterology Associates PC CurrentSince Jun 1, 2021 Accepting new patients
Edward W. Sparrow Hospital Association CurrentSince Apr 4, 2024 Accepting new patients
Edward W Sparrow Hospital Association CurrentSince Apr 4, 2024 Accepting new patients
Essential Anesthesia Services, PLC Nurse Anesthetist, Certified Registered CurrentSince Jul 2, 2012 Accepting new patients
Chelsea Community Hospital Nurse Anesthetist, Certified Registered CurrentSince Sep 29, 2014 Accepting new patients
Huron Gastroenterology Associates PC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2021 Accepting new patients
Chelsea Community Hospital CurrentSince Sep 29, 2014 Accepting new patients
Gastrointestinal Specialists PC CurrentSince Jul 2, 2012 Accepting new patients
Edward W. Sparrow Hospital Association Nurse Anesthetist, Certified Registered CurrentSince Apr 4, 2024 Accepting new patients
Center for Digestive Care LLC CurrentSince Apr 18, 2018 Accepting new patients
Edward W. Sparrow Hospital Association Current Accepting new patients

Locations

8175 Reliable Pkwy
Chicago, IL 60686

775 S Main St
Chelsea, MI 48118
Phone (313) 995-3764

620 Byron Rd
Howell, MI 48843
Phone (517) 545-5450

1707 Lake Lansing Rd
Lansing, MI 48912
Phone (517) 267-0033

2909 E Grand River Ave
Ste 201
Lansing, MI 48912
Phone (517) 253-3050

1215 E Michigan Ave
Lansing, MI 48912
Phone (517) 336-8080

36650 5 Mile Rd
Ste 100
Livonia, MI 48154
Phone (734) 432-0314

800 E Columbia St
Mason, MI 48854
Phone (517) 244-8900

264 W Maple Rd
Ste 100
Troy, MI 48084
Phone (248) 269-5594

264 W Maple Rd
Ste 200
Troy, MI 48084
Phone (248) 273-9930

5300 Elliott Dr
Ypsilanti, MI 48197
Phone (734) 434-6262

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 11

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185408000000",
    "number": "1619934411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34800 BOB WILSON DR",
            "address_2": "NMCSD, ATTN: MEDICAL STAFF SERVICES",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921341098",
            "telephone_number": "619-532-6460",
            "fax_number": "619-532-6299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34800 BOB WILSON DR",
            "address_2": "NMCSD, ATTN: MEDICAL STAFF SERVICES",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921341098",
            "telephone_number": "619-532-6460",
            "fax_number": "619-532-6299"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHON",
        "first_name": "KEITH",
        "middle_name": "LEONARD",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-27",
        "last_updated": "2007-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CA",
            "license": "074376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2007; 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.