Individual provider Active NPI

Michael Ray Nordyke, CRNA

  • Certified Registered Nurse Anesthetist
  • Columbia, MO
National Provider Identifier
1659857712
Registry record updated Jul 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
2018022129 Issued in MO
Practice address
1600 E Broadway
Columbia, MO 65201-5844
Phone
(573) 815-8000
NPI assigned
Jul 12, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2018

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 2018022129 MO Primary

Addresses

Primary practice location

1600 E Broadway
Columbia, MO 65201-5844

Mailing address

1316 Old Highway 63 S Ste 102
Columbia, MO 65201-6092
Phone (573) 875-8838

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180821002981 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 5193074375 Reassigns benefits to 1 organization

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
Mid-America Anesthesia Consultants PCGroup PAC ID 6305837626, 49 clinicians

Practice addresses (Care Compare)

1600 E Broadway
Columbia, MO 65201-5844
Phone (573) 815-5511

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2018022129MOMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-America Anesthesia Consultants, PC CurrentSince Jul 25, 2018 Accepting new patients
Mid-America Anesthesia Services, LLC Past Accepting new patients

Locations

1316 Old Highway 63 S
Ste 102
Columbia, MO 65201
Phone (573) 875-8838

1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000

1600 E Broadway
Ste 60
Columbia, MO 65201

Organizations & group practices 2

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 2

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": "1531353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531353600000",
    "number": "1659857712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1316 OLD HIGHWAY 63 S STE 102",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652016092",
            "telephone_number": "573-875-8838",
            "fax_number": "573-875-8589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 E BROADWAY",
            "city": "COLUMBIA",
            "state": "MO",
            "postal_code": "652015844",
            "telephone_number": "573-815-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NORDYKE",
        "first_name": "MICHAEL",
        "middle_name": "RAY",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-12",
        "last_updated": "2018-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2018022129",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbia, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; 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.