NPIMap

Individual provider Active NPI

Matthew James Michener, CRNA, DNP

  • Certified Registered Nurse Anesthetist
  • Neenah, WI
National Provider Identifier
1750055877
Registry record updated Sep 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
226541-30 Issued in WI
Practice address
130 2ND St
Neenah, WI 54956-2883
Phone
(920) 729-3100
NPI assigned
Aug 3, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 16, 2021

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 226541-30 WI Primary

Addresses

Primary practice location

130 2ND St
Neenah, WI 54956-2883

Mailing address

2109B E Capitol Dr Ste 1
Appleton, WI 54911-8726
Phone (844) 693-1482

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210823001128 WI Practitioner - Certified Registered Nurse Anesthetist (Crna) 6608271143 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Association of Hospital Anesthesiologists SCGroup PAC ID 3476539875, 84 clinicians

Practice addresses (Care Compare)

130 2ND St
Neenah, WI 54956-2883
Phone (920) 729-3100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
226541-30WIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Association of Hospital Anesthesiologists SC CurrentSince Sep 1, 2021 Accepting new patients

Locations

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

736 Ford St
Kimberly, WI 54136

130 2nd St
#A107
Neenah, WI 54956

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

Organizations & group practices 1

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 12

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": "1627948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631750400000",
    "number": "1750055877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109B E CAPITOL DR STE 1",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118726",
            "telephone_number": "844-693-1482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 2ND ST",
            "city": "NEENAH",
            "state": "WI",
            "postal_code": "549562883",
            "telephone_number": "920-729-3100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHENER",
        "first_name": "MATTHEW",
        "middle_name": "JAMES",
        "credential": "CRNA, DNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-08-03",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "226541-30",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Neenah, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; 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.