NPIMap

Individual provider Active NPI

Michael Alto Wislocki, CRNA

  • Certified Registered Nurse Anesthetist
  • Louisville, KY
National Provider Identifier
1699752352
Registry record updated Oct 11, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3231A Issued in KY
Practice address
1 Audubon Plaza Dr
Louisville, KY 40217-1319
Phone
(502) 636-7449
Fax
(502) 636-7950
NPI assigned
Dec 23, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 11, 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 3231A KY Primary

Addresses

Primary practice location

1 Audubon Plaza Dr
Louisville, KY 40217-1319

Mailing address

Dept 86236
PO Box 950195
Louisville, KY 40295-0195
Phone (502) 473-2100

Other identifiers 1

IdentifierTypeStateIssuer
74001892MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040621000052 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 1658356142 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Professional Anesthesia Services of Kentucky PLLCGroup PAC ID 0244590305, 351 clinicians

Practice addresses (Care Compare)

200 E Chestnut St
Louisville, KY 40202-1831
Phone (502) 629-8000

4000 Kresge Way
Louisville, KY 40207-4605
Phone (502) 897-8100

4960 Norton Healthcare Blvd
Louisville, KY 40241-2831
Phone (502) 446-8000

850 S 28TH St
Louisville, KY 40211-1223
Phone (502) 629-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3231AKYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Anesthesia Services of Kentucky PLLC Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2019 Accepting new patients
Kentucky Anesthesia Group, PSC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2015 Accepting new patients
Norton Anesthesia Services Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

231 E Chestnut St
Louisville, KY 40202
Phone (502) 852-8500

200 E Chestnut St
Louisville, KY 40202
Phone (502) 446-8000

850 S 28th St
Louisville, KY 40211
Phone (502) 629-7650

9 Linville Dr
Paris, KY 40361
Phone (859) 987-3600

Organizations & group practices 3

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1192060800000",
    "number": "1699752352",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "DEPT 86236",
            "address_2": "PO BOX 950195",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402950195",
            "telephone_number": "502-473-2100",
            "fax_number": "502-459-6461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 AUDUBON PLAZA DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171319",
            "telephone_number": "502-636-7449",
            "fax_number": "502-636-7950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WISLOCKI",
        "first_name": "MICHAEL",
        "middle_name": "ALTO",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-23",
        "last_updated": "2007-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3231A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74001892",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.