Individual provider Active NPI

Michael D Cunningham Jr., CRNA

  • Certified Registered Nurse Anesthetist
  • Lafayette, LA
National Provider Identifier
1790895902
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
04858 Issued in LA
Practice address
611 Saint Landry St
Lafayette, LA 70506-4627
Phone
(337) 289-2966
Fax
(337) 289-2776
NPI assigned
Aug 30, 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 04858 LA Primary

Addresses

Primary practice location

611 Saint Landry St
Lafayette, LA 70506-4627

Mailing address

PO Box 53864
Lafayette, LA 70505-3864
Phone (337) 289-2966

Other identifiers 1

IdentifierTypeStateIssuer
1369217MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060321000242 LA Practitioner - Certified Registered Nurse Anesthetist (Crna) 3072520790 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Pacific Medical College, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesiology Group Associates IncGroup PAC ID 0042110298, 155 clinicians

Practice addresses (Care Compare)

5000 Hennessy Blvd
Baton Rouge, LA 70808-4375
Phone (225) 765-6565

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
04858LAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesiology Group Associates Inc CurrentSince May 1, 2017 Accepting new patients
Precision Anesthesia of Lafayette LLC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2018 Accepting new patients
Youngs Professional Services LLC Nurse Anesthetist, Certified Registered CurrentSince May 23, 2016 Accepting new patients

Locations

11414 Lake Sherwood Ave N
Baton Rouge, LA 70816
Phone (225) 532-4058

5000 Hennessy Blvd
Baton Rouge, LA 70808
Phone (225) 765-4050

7777 Hennessy Blvd
Ste 301
Baton Rouge, LA 70808
Phone (225) 214-6436

9032 Perkins Rd
Baton Rouge, LA 70810
Phone (225) 358-4853

1101 S College Rd
Ste 100
Lafayette, LA 70503
Phone (337) 233-8603

1105 Kaliste Saloom Rd
Lafayette, LA 70508
Phone (225) 296-0041

443 Heymann Blvd
Lafayette, LA 70503
Phone (337) 234-4535

1100 Andre St
Ste 300
New Iberia, LA 70563
Phone (337) 364-9225

Organizations & group practices 3

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": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1790895902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 53864",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705053864",
            "telephone_number": "337-289-2966",
            "fax_number": "337-289-2776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 SAINT LANDRY ST",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705064627",
            "telephone_number": "337-289-2966",
            "fax_number": "337-289-2776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CUNNINGHAM",
        "first_name": "MICHAEL",
        "middle_name": "D",
        "name_suffix": "Jr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "LA",
            "license": "04858",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1369217",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, LA

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.