Individual provider Active NPI

Teresa M Koelzer, CRNA

  • Certified Registered Nurse Anesthetist
  • Grand Rapids, MI
National Provider Identifier
1679536718
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704141580 Issued in MI
Practice address
1919 Boston St SE
Metro Health - Hospital
Grand Rapids, MI 49506-4160
Phone
(616) 808-3944
Fax
(616) 808-3948
NPI assigned
Apr 10, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 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 4704141580 MI Primary

Addresses

Primary practice location

1919 Boston St SE
Metro Health - Hospital
Grand Rapids, MI 49506-4160

Mailing address

400 Ann St NW
Suite 209
Grand Rapids, MI 49504-2052
Phone (616) 808-3944

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

Practice roles

OrganizationSpecialtyStatusNew patients
Metropolitan Anesthesia Associates, PC Nurse Anesthetist, Certified Registered Past Accepting new patients
Metropolitan Anesthesia Associates, P.C. Nurse Anesthetist, Certified Registered Past Accepting new patients
Advantage Health Physicians PC Past Accepting new patients
Central Anesthesia Services, PC Nurse Anesthetist, Certified Registered Past Accepting new patients
West Coast Anesthesia PLLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Pine Rest Christian Mental Health Services Past Accepting new patients

Organizations & group practices 6

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": "1144627200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1679536718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 ANN ST NW",
            "address_2": "SUITE 209",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495042052",
            "telephone_number": "616-808-3944",
            "fax_number": "616-808-3948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 BOSTON ST SE",
            "address_2": "METRO HEALTH - HOSPITAL",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495064160",
            "telephone_number": "616-808-3944",
            "fax_number": "616-808-3948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOELZER",
        "first_name": "TERESA",
        "middle_name": "M",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-10",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704141580",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

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.

Verify at the official NPI Registry.