Individual provider Active NPI

Terri L Haney, CRNA

  • Certified Registered Nurse Anesthetist
  • Ann Arbor, MI
National Provider Identifier
1700854965
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704104516 Issued in MI
Practice address
1500 East Medical Center Dr
Ann Arbor, MI 48109-0048
Phone
(734) 936-4280
NPI assigned
Mar 14, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 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 4704104516 MI Primary

Addresses

Primary practice location

1500 East Medical Center Dr
Ann Arbor, MI 48109-0048

Mailing address

3621 S State St
700 KMS Place
Ann Arbor, MI 48108
Phone (734) 936-2047

Other identifiers 2

IdentifierTypeStateIssuer
4167611MedicaidMI
4441068MedicaidMI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190618002471 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 1355470469 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Endo Sedation LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 10, 2020 Accepting new patients
Endo Sedation LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 10, 2020 Accepting new patients
Endo Sedation LLC Nurse Anesthetist, Certified Registered Current Accepting new patients
Amtx Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2019 Accepting new patients

Locations

1090 Experiment Station Rd
Unit 529
Watkinsville, GA 30677
Phone (706) 621-4108

800 Quail Creek Dr
Ste 102
Amarillo, TX 79124
Phone (806) 367-8537

950 N 14th St
Ste 100
Beaumont, TX 77702
Phone (409) 833-5555

1001 Surrey Ln
Flower Mound, TX 75022
Phone (817) 337-3671

180 Bear Creek Pkwy
Keller, TX 76248
Phone (817) 337-3671

3610 24th St
Lubbock, TX 79410
Phone (806) 793-3141

2704 N Galloway Ave
Ste 102
Mesquite, TX 75150
Phone (972) 961-7171

1015 W Medical Center Blvd
Ste 1200
Webster, TX 77598
Phone (281) 554-3494

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1142294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1700854965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "address_2": "700 KMS PLACE",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48108",
            "telephone_number": "734-936-2047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 EAST MEDICAL CENTER DR",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481090048",
            "telephone_number": "734-936-4280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HANEY",
        "first_name": "TERRI",
        "middle_name": "L",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704104516",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4167611",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4441068",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.