Individual provider Active NPI

Stanley M. Michelcavage, CRNA

  • Certified Registered Nurse Anesthetist
  • Port Huron, MI
National Provider Identifier
1750482568
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704151696 Issued in MI
Practice address
2601 Electric Ave
Port Huron, MI 48060-6587
Phone
(810) 985-1500
Fax
(810) 966-3104
NPI assigned
Sep 26, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
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 4704151696 MI Primary

Addresses

Primary practice location

2601 Electric Ave
Port Huron, MI 48060-6587

Mailing address

2614 Farmdale Dr
Sterling Heights, MI 48314-3868

Other identifiers 3

IdentifierTypeStateIssuer
425219610MedicaidMI
SM151696OtherMIBLUE CROSS
P100918OtherMIBCN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090216000353 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 3577628106 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Associates of Ann Arbor PLLCGroup PAC ID 1355317223, 213 clinicians

Practice addresses (Care Compare)

44405 Woodward Ave
Pontiac, MI 48341-5023
Phone (248) 585-3023

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
67.5 of 100Reported as group
Quality
58.12
Improvement activities
40
Cost
68.45

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Henry Ford Health Macomb-Oakland Hospital CurrentSince Jul 1, 2007 Accepting new patients
Anesthesia Associates of Ann Arbor, PLLC Nurse Anesthetist, Certified Registered CurrentSince May 1, 2018 Accepting new patients
Henry Ford Health Macomb-Oakland Hospital Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2007 Accepting new patients
Waterford Surgical Center, LLC Past Accepting new patients
St. Joseph Mercy Hospital Crna Group Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

7924 Solutions Ctr Dr
Chicago, IL 60677

2006 Hogback Rd
Ste 5
Ann Arbor, MI 48105
Phone (313) 712-4331

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

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

44405 Woodward Ave
Pontiac, MI 48341
Phone (248) 858-3000

1560 E Maple Rd
Troy, MI 48083
Phone (248) 581-5729

1560 E Maple Rd
#100
Troy, MI 48083
Phone (248) 817-2001

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": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750482568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2614 FARMDALE DR",
            "city": "STERLING HEIGHTS",
            "state": "MI",
            "postal_code": "483143868"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2601 ELECTRIC AVE",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606587",
            "telephone_number": "810-985-1500",
            "fax_number": "810-966-3104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICHELCAVAGE",
        "first_name": "STANLEY",
        "middle_name": "M.",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-26",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704151696",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "425219610",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "SM151696",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCN",
            "identifier": "P100918",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, 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.
  • 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.