Individual provider Active NPI

Michele Bonneau, CRNA

  • Certified Registered Nurse Anesthetist
  • Hammond, IN
National Provider Identifier
1790772390
Registry record updated Dec 26, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
28057819A Issued in IN
Practice address
5454 Hohman Ave
Hammond, IN 46320-1931
Phone
(219) 933-2022
NPI assigned
Sep 29, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 26, 2013

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 28057819A IN Primary

Addresses

Primary practice location

5454 Hohman Ave
Hammond, IN 46320-1931

Mailing address

150 Shore Dr
Ogden Dunes, IN 46368-7749
Phone (219) 762-7229

Other identifiers 1

IdentifierTypeStateIssuer
200043290MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040324001196 IN Practitioner - Certified Registered Nurse Anesthetist (Crna) 7618868837 Reassigns benefits to 1 organization
I20220830002103 IL Practitioner - Anesthesiology Assistant 7618868837 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1993
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northstar Anesthesia of Indiana LLC 130 clinicians

Practice addresses (Care Compare)

24 Joliet St
Dyer, IN 46311-1705
Phone (219) 865-2141

701 Superior Ave
Munster, IN 46321-4037
Phone (219) 922-4200

Hospital & facility affiliations

  • Franciscan Health Dyer Hospital, Dyer, IN, CCN 150090
  • Franciscan Health Munster Hospital, Munster, IN, CCN 150165

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
28057819AINMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of Indiana LLC Nurse Anesthetist, Certified Registered CurrentSince Dec 29, 2012 Accepting new patients
Northstar Anesthesia of Illinois, LLC Nurse Anesthetist, Certified Registered CurrentSince May 19, 2022 Accepting new patients

Locations

13500 Powers Ct
Ste 230
Fort Myers, FL 33912
Phone (239) 610-0784

1423 Chicago Rd
Sauk Village, IL 60411
Phone (708) 679-2160

12800 Mississippi Pkwy
Crown Point, IN 46307
Phone (219) 662-5560

1201 S Main St
Crown Point, IN 46307
Phone (219) 738-2100

24 Joliet St
Dyer, IN 46311
Phone (219) 864-2237

5454 Hohman Ave
Hammond, IN 46320
Phone (219) 933-2077

701 Superior Ave
Munster, IN 46321
Phone (219) 922-4200

Interoperability endpoints

  • Direct secure messaging: mbonneau56659@direct.franciscanalliance.org

Organizations & group practices 2

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": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388016000000",
    "number": "1790772390",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 SHORE DR",
            "city": "OGDEN DUNES",
            "state": "IN",
            "postal_code": "463687749",
            "telephone_number": "219-762-7229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5454 HOHMAN AVE",
            "city": "HAMMOND",
            "state": "IN",
            "postal_code": "463201931",
            "telephone_number": "219-933-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONNEAU",
        "first_name": "MICHELE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-29",
        "last_updated": "2013-12-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "28057819A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200043290",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hammond, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2013; 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.