Tom R Pankratz, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

042315 Issued in WI

Practice address

707 14TH St
Baraboo, WI 53913-1539

Phone

(608) 356-1400

NPI assigned

Nov 17, 2005

Last updated

Mar 9, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• SSM Health Care of Wisconsin Inc

  • Internal Medicine Physician
  • Baraboo, WI
  • NPI 1730160011
  NPD
• SSM Health Care of Wisconsin Inc

  • Certified Registered Nurse Anesthetist
  • Baraboo, WI
  • NPI 1336120401

  Nurse Anesthetist, Certified Registered

  NPD (past)
• SSM Health Care of Wisconsin Inc

  • Registered Dietitian
  • Baraboo, WI
  • NPI 1467435214
  NPD (past)
• SSM Health Care of Wisconsin, Inc.

  dba St Clare Dialysis Center

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Baraboo, WI
  • NPI 1053392845
  NPD (past)
• SSM Health Treatment and Recovery Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Baraboo, WI
  • NPI 1124094263
  NPD (past)
• SSM Healthcare of Wi Inc

  dba St Clare Hospital and Health

  • Audiologist
  • Baraboo, WI
  • NPI 1316909781
  NPD (past)
• SSM Healthcare of Wi Inc

  • Clinical Medical Laboratory
  • Baraboo, WI
  • NPI 1346229697
  NPD (past)

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

{
    "created_epoch": "1132185600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1268092800000",
    "number": "1699757492",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 14TH ST",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539131539",
            "telephone_number": "608-356-1400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 14TH ST",
            "city": "BARABOO",
            "state": "WI",
            "postal_code": "539131539",
            "telephone_number": "608-356-1400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANKRATZ",
        "first_name": "TOM",
        "middle_name": "R",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-17",
        "last_updated": "2010-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "042315",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL INS PROV #",
            "identifier": "391023846",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEANCARE PROV #",
            "identifier": "551896",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE PROV #",
            "identifier": "388407992",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43322800",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYS PLUS PROV #",
            "identifier": "1009390",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PROV #",
            "identifier": "430054481",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Oral Surgery Center, S.C.
• Orthodontic Specialists, SC
• Barbara Ostrowski, RN
• Samuel Overlien, LCSW
• Kelly Ann Palmer, MSW, LCSW
• Chad M Parchem, D.C.
• Jenny Rose Park, MD, MCR
• Emily J Parker, O.D.
• Teresa Parker, MSW, CICSW
• Mark D Paschen, DDS

• Certified Registered Nurse Anesthetist in Baraboo, WI
• Providers in Baraboo, WI by specialty
• Certified Registered Nurse Anesthetist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2010; 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.