Individual provider Active NPI

Naeam Wilkerson, CRNA

  • Certified Registered Nurse Anesthetist
  • Warren, MI
National Provider Identifier
1740451590
Registry record updated Mar 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704236428 Issued in MI
Practice address
11800 E 12 Mile Rd
Warren, MI 48093-3472
Phone
(586) 573-5261
Fax
(586) 573-5364
NPI assigned
Mar 20, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2008

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 4704236428 MI Primary

Addresses

Primary practice location

11800 E 12 Mile Rd
Warren, MI 48093-3472

Mailing address

11800 E 12 Mile Rd
Warren, MI 48093-3472
Phone (586) 573-5261

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080728000116 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 0840363610 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Henry Ford Health Macomb Oakland HospitalGroup PAC ID 7315859725, shared by 8 NPIs, 155 clinicians

Practice addresses (Care Compare)

11800 E 12 Mile Rd
Warren, MI 48093-3472
Phone (586) 573-5000

27351 Dequindre Rd
Madison Heights, MI 48071-3487
Phone (248) 967-7000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4704236428MIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of Michigan PLLC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2015 Accepting new patients
Eastside Group LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 24, 2009 Accepting new patients
Henry Ford Health Macomb Oakland Hospital Nurse Anesthetist, Certified Registered CurrentSince Jan 14, 2008 Accepting new patients
Henry Ford Health Macomb-Oakland Hospital Nurse Anesthetist, Certified Registered CurrentSince Nov 1, 2012 Accepting new patients
Henry Ford Health Macomb-Oakland Hospital CurrentSince Jan 14, 2008 Accepting new patients

Locations

7920 Solutions Ctr Dr
Chicago, IL 60677

7924 Solutions Ctr Dr
Chicago, IL 60677

1 William Carls Dr
Commerce Twp, MI 48382
Phone (248) 227-5500

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

3990 John R St
Detroit, MI 48201
Phone (313) 745-6211

17700 23 Mile Rd
Ste 250
Macomb, MI 48044
Phone (586) 416-7500

27351 Dequindre Rd
Madison Hts, MI 48071
Phone (248) 967-7000

28963 Little Mack Ave
Ste 10
St Clr Shores, MI 48081
Phone (586) 447-5110

28963 Little Mack Ave
Ste 103
St Clr Shores, MI 48081
Phone (586) 447-5110

11800 E 12 Mile Rd
Warren, MI 48093
Phone (586) 573-5000

Interoperability endpoints

  • Direct secure messaging: nwilkerson1157594@direct.hfhs.org

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1205971200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205971200000",
    "number": "1740451590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11800 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933472",
            "telephone_number": "586-573-5261",
            "fax_number": "586-573-5364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11800 E 12 MILE RD",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480933472",
            "telephone_number": "586-573-5261",
            "fax_number": "586-573-5364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILKERSON",
        "first_name": "NAEAM",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-20",
        "last_updated": "2008-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704236428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Warren, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2008; 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.