Active NPI
Michele Bonneau, CRNA
- Certified Registered Nurse Anesthetist
- Hammond, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 28057819A
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200043290 | Medicaid | IN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN, IL
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
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
- Franciscan Health Munster
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28057819A | IN | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northstar Anesthesia of Indiana LLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Northstar Anesthesia of Illinois, LLC | Nurse Anesthetist, Certified Registered | Current | 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
- 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.
-
- Anesthesiology Physician
- Arlington, TX
- NPI 1043561541
IN, Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Arlington, TX
- NPI 1962822395
IL, Nurse Anesthetist, Certified Registered
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.