Individual provider Active NPI

Angelique Jenelle Gwin, CRNA

  • Certified Registered Nurse Anesthetist
  • Ann Arbor, MI
National Provider Identifier
1770689325
Registry record updated Dec 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704246817 Issued in MI
Practice address
1500 E Medical Center Dr
1H247 University Hospital
Ann Arbor, MI 48109
Phone
(734) 936-4280
NPI assigned
Sep 14, 2006
Last updated
Dec 13, 2018By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 13, 2018

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 4704246817 MI Primary

Addresses

Primary practice location

1500 E Medical Center Dr
1H247 University Hospital
Ann Arbor, MI 48109

Mailing address

3621 S State St
Ann Arbor, MI 48108-1633
Phone (734) 647-5299

Other identifiers 1

IdentifierTypeStateIssuer
4816002MedicaidMI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050705000500 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 6406892132 Reassigns benefits to 1 organization
I20060117001119 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 6406892132 Reassigns benefits to 7 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians

Practice addresses (Care Compare)

1000 Wall St
Ann Arbor, MI 48105-1912
Phone (734) 936-4000

1500 E Medical Ctr Dr
Ann Arbor, MI 48109-5000
Phone (734) 936-4000

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-4000

4270 Plymouth Rd
Ann Arbor, MI 48109-2700
Phone (734) 936-4000

5640 N Adrian Hwy
Adrian, MI 49221-8318
Phone (419) 291-4491

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Feb 21, 2024 Accepting new patients
Northwestern Services, LLC CurrentSince Jun 18, 2022 Accepting new patients
Northwestern Services, LLC Nurse Anesthetist, Certified Registered CurrentSince Jun 18, 2022 Accepting new patients
PSJ Anesthesia PC Nurse Anesthetist, Certified Registered CurrentSince Jan 31, 2016 Accepting new patients
West Michigan Aas LLC CurrentSince Apr 12, 2022 Accepting new patients
Regents of the University of Michigan Nurse Anesthetist, Certified Registered CurrentSince Nov 28, 2017 Accepting new patients
Promedica Central Corporation of Michigan CurrentSince Jan 22, 2024 Accepting new patients
Promedica Central Physicians CurrentSince Feb 21, 2024 Accepting new patients
Michigan Crnas Staffing LLC CurrentSince May 20, 2022 Accepting new patients
Regents of the University of Michigan CurrentSince Nov 28, 2017 Accepting new patients
Anesthesiology Consultants of Toledo, Inc Past Accepting new patients
Henry Ford Health Providence Hospital Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

5640 N Adrian Hwy
Adrian, MI 49221
Phone (419) 291-3000

1500 E Medical Center Dr
#1H247
Ann Arbor, MI 48109
Phone (734) 936-4280

3621 S State St
Ann Arbor, MI 48108
Phone (734) 647-5229

4270 Plymouth Rd
Ann Arbor, MI 48109
Phone (734) 232-3000

30400 Telegraph Rd
Ste 405
Bingham Farms, MI 48025
Phone (248) 483-8138

17000 Executive Plaza Dr
Ste 301
Dearborn, MI 48126
Phone (313) 408-6613

30055 Northwestern Hwy
Farmington Hills, MI 48334
Phone (248) 626-8200

30055 Northwestern Hwy
Ste L-60
Farmington Hills, MI 48334
Phone (248) 265-6555

4024 Park East Ct SE
Grand Rapids, MI 49546
Phone (231) 592-3102

1030 N Monroe St
Ste 2
Monroe, MI 48162
Phone (734) 682-3309

26750 Providence Pkwy
Ste 100
Novi, MI 48374
Phone (248) 662-1500

43422 W Oaks Dr
Novi, MI 48377
Phone (248) 229-4658

47601 Grand River Ave
Novi, MI 48374
Phone (248) 465-4100

16001 W 9 Mile Rd
Southfield, MI 48075
Phone (248) 424-3000

200 E Russell Rd
Unit C
Tecumseh, MI 49286
Phone (517) 424-3883

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

5200 Harroun Rd
Sylvania, OH 43560
Phone (419) 824-1305

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 5

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": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544659200000",
    "number": "1770689325",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3621 S STATE ST",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "481081633",
            "telephone_number": "734-647-5299"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E MEDICAL CENTER DR",
            "address_2": "1H247 UNIVERSITY HOSPITAL",
            "city": "ANN ARBOR",
            "state": "MI",
            "postal_code": "48109",
            "telephone_number": "734-936-4280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWIN",
        "first_name": "ANGELIQUE",
        "middle_name": "JENELLE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2018-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704246817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4816002",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ann Arbor, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2018; 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.