John M Mazzara, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

4704131712 Issued in MI

Practice address

1101 W University Dr
Rochester, MI 48307-1863

Phone

(248) 652-5354

Fax

(248) 652-5861

NPI assigned

Jan 19, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330905600000",
    "number": "1720131279",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 VREELAND DR",
            "city": "ROCHESTER HILLS",
            "state": "MI",
            "postal_code": "483091906",
            "telephone_number": "248-375-9019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 W UNIVERSITY DR",
            "city": "ROCHESTER",
            "state": "MI",
            "postal_code": "483071863",
            "telephone_number": "248-652-5354",
            "fax_number": "248-652-5861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZARA",
        "first_name": "JOHN",
        "middle_name": "M",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2012-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704131712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "430F364550",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1819520",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Amanda Mazzoli
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• Kenneth Paul McCauley, DC

• Certified Registered Nurse Anesthetist in Rochester, MI
• Providers in Rochester, MI by specialty
• Certified Registered Nurse Anesthetist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2012; 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.