Individual provider Active NPI

Justin West, CRNA

  • Certified Registered Nurse Anesthetist
  • Jackson, MI
National Provider Identifier
1639643075
Registry record updated May 9, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704304021 Issued in MI
Practice address
205 N East Ave
Jackson, MI 49201-1753
Phone
(517) 205-7836
NPI assigned
Jan 18, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 125160 VA
Certified Registered Nurse Anesthetist 367500000X APRN11001696 FL
Certified Registered Nurse Anesthetist 367500000X 4704304021 MI Primary

Addresses

Primary practice location

205 N East Ave
Jackson, MI 49201-1753

Mailing address

1058 N Tamiami TRL
Apt 108 #231
Sarasota, FL 34236-2427
Phone (734) 846-2388

Other practice location 1

1261 S Tamiami Trl
Sarasota, FL 34239-2219
Phone (941) 366-1164

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220510001094 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 9335481068 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

205 N E Ave
Henry Ford Allegiance Health
Jackson, MI 49201-1753
Phone (517) 205-4800

5640 N Adrian Hwy
Adrian, MI 49221-8318
Phone (419) 291-4491

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125160VAMDAnesthesiology Physician
APRN11001696FLMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health St. John Hospital Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2024 Accepting new patients
Superior Anesthetists Associates, Inc. CurrentSince Aug 21, 2023 Accepting new patients
Northstar Anesthesia of Michigan III PLLC Nurse Anesthetist, Certified Registered CurrentSince Dec 13, 2022 Accepting new patients
Henry Ford Health St. John Hospital CurrentSince Dec 1, 2024 Accepting new patients
Nsa Pain Services of Michigan III, PLLC CurrentSince Dec 13, 2022 Accepting new patients
Promedica Central Corporation of Michigan Anesthesiology CurrentSince Jun 8, 2023 Accepting new patients
Sarasota Anesthesia Past Accepting new patients

Locations

7915 Solutions Ctr Dr
Chicago, IL 60677

5640 N Adrian Hwy
Adrian, MI 49221
Phone (419) 291-3000

22101 Moross Rd
Detroit, MI 48236
Phone (313) 343-3248

5202 Miller Rd
Flint, MI 48507
Phone (810) 720-8900

3175 Smith Rd
Lambertville, MI 48144
Phone (734) 856-5494

718 N Macomb St
Monroe, MI 48162
Phone (734) 212-3097

920 River Centre Dr
Port Huron, MI 48060
Phone (810) 984-5200

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

200 E Russell Rd
Unit C
Tecumseh, MI 49286
Phone (517) 424-3883

33155 Annapolis St
Wayne, MI 48184
Phone (734) 467-4042

Interoperability endpoints

  • Direct secure messaging: jwest790539@direct.hfhs.org

Organizations & group practices 8

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": "1547769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652054400000",
    "number": "1639643075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1058 N TAMIAMI TRL",
            "address_2": "APT 108 #231",
            "city": "SARASOTA",
            "state": "FL",
            "postal_code": "342362427",
            "telephone_number": "734-846-2388"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N EAST AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011753",
            "telephone_number": "517-205-7836"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1261 S Tamiami Trl",
            "address_purpose": "LOCATION",
            "city": "Sarasota",
            "state": "FL",
            "postal_code": "342392219",
            "country_code": "US",
            "telephone_number": "941-366-1164",
            "fax_number": "941-365-1387",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WEST",
        "first_name": "JUSTIN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-18",
        "last_updated": "2022-05-09",
        "certification_date": "2022-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "125160",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "APRN11001696",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704304021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2022; 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.