Individual provider Active NPI

Mark D Burkhart, CRNA

  • Certified Registered Nurse Anesthetist
  • Grand Blanc, MI
National Provider Identifier
1710502364
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704321188 Issued in MI
Practice address
1 Genesys Pkwy
Grand Blanc, MI 48439-8065
Phone
(810) 606-5000
NPI assigned
Jun 10, 2020
Last updated
Jun 10, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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 4704321188 MI Primary

Addresses

Primary practice location

1 Genesys Pkwy
Grand Blanc, MI 48439-8065

Mailing address

48080 Colony Farm Cir
Plymouth, MI 48170-3305
Phone (910) 581-1466

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201027002071 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 7416367719 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Conquest Pain Management LLCGroup PAC ID 6608167234, 5 clinicians
Sjmhs Anesthesia ServicesGroup PAC ID 7416053483, 103 clinicians

Practice addresses (Care Compare)

15750 Northline Rd
Southgate, MI 48195-2378
Phone (734) 357-0505

31995 Northwestern Hwy
Farmington Hills, MI 48334-1625
Phone (800) 527-6266

5301 E Huron River Dr
Ypsilanti, MI 48197-1051
Phone (734) 712-3456

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Conquest Pain Management, LLC Nurse Anesthetist, Certified Registered CurrentSince Apr 10, 2024 Accepting new patients
Sjmhs Anesthesia Services Nurse Anesthetist, Certified Registered CurrentSince Sep 26, 2020 Accepting new patients
Sjmhs Anesthesia Services Nurse Anesthetist, Certified Registered CurrentSince Sep 26, 2020 Accepting new patients
Sjmhs Anesthesia Services Current Accepting new patients
Northstar Anesthesia of Michigan PLLC Nurse Anesthetist, Certified Registered CurrentSince Oct 15, 2020 Accepting new patients

Locations

4 Columbus Ave
Ste 260
Bay City, MI 48708
Phone (989) 308-1840

4201 Saint Antoine St
Detroit, MI 48201
Phone (313) 745-3615

31995 Northwestern Hwy
Farmington Hills, MI 48334
Phone (248) 538-4701

620 Byron Rd
Howell, MI 48843
Phone (517) 545-5450

375 Barclay Cir
Rochester Hills, MI 48307
Phone (248) 491-8894

29877 Telegraph Rd
Southfield, MI 48034
Phone (248) 352-1890

15750 Northline Rd
Southgate, MI 48195
Phone (248) 798-3130

43145 Schoenherr Rd
Unit 13
Sterling Heights, MI 48313
Phone (586) 997-5048

3290 W Big Beaver Rd
Ste 150
Troy, MI 48084
Phone (248) 792-6527

2333 Progress St
West Branch, MI 48661
Phone (989) 343-3178

5301 McAuley Dr
Ypsilanti, MI 48197
Phone (734) 712-7246

400 10th St E
Waconia, MN 55387

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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": "1591747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1710502364",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "48080 COLONY FARM CIR",
            "city": "PLYMOUTH",
            "state": "MI",
            "postal_code": "481703305",
            "telephone_number": "910-581-1466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 GENESYS PKWY",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398065",
            "telephone_number": "810-606-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKHART",
        "first_name": "MARK",
        "middle_name": "D",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-10",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704321188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Blanc, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; 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.