Individual provider Active NPI

Lisa Goldboss-Sullivan, CRNA

  • Certified Registered Nurse Anesthetist
  • Saginaw, MI
National Provider Identifier
1851431639
Registry record updated Apr 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704223989 Issued in MI
Practice address
1447 N Harrison St
Saginaw, MI 48602-4727
Phone
(989) 583-6237
NPI assigned
Feb 8, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2014

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 4704223989 MI Primary

Addresses

Primary practice location

1447 N Harrison St
Saginaw, MI 48602-4727

Mailing address

3690 White Trillium Dr E
Saginaw, MI 48603-1939

Other names 1

  • Lisa Goldboss Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100219000488 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 0143364703 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Medical Center, Inc.Group PAC ID 2769387778, 488 clinicians

Practice addresses (Care Compare)

1447 N Harrison St
Saginaw, MI 48602-4727
Phone (989) 583-6237

700 Cooper Ave
Saginaw, MI 48602-5383
Phone (989) 791-0452

Hospital & facility affiliations

  • Covenant Medical Center Hospital, Saginaw, MI, CCN 230070

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4704223989MIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Covenant Medical Center, Inc. Nurse Anesthetist, Certified Registered CurrentSince May 10, 2000 Accepting new patients
Covenant Medical Center, Inc CurrentSince May 10, 2000 Accepting new patients

Locations

1447 N Harrison St
Saginaw, MI 48602
Phone (989) 583-4220

700 Cooper Ave
Saginaw, MI 48602
Phone (989) 583-6000

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 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": "1170892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1398124800000",
    "number": "1851431639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3690 WHITE TRILLIUM DR E",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486031939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1447 N HARRISON ST",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486024727",
            "telephone_number": "989-583-6237"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDBOSS-SULLIVAN",
        "first_name": "LISA",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-08",
        "last_updated": "2014-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704223989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "GOLDBOSS",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Saginaw, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2014; 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.