Active NPI
Diane L Hartzog, CRNA
- Anesthesiologist Assistant
- Watertown, WI
National Provider Identifier
1871538744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiologist Assistant
- License
- 78920030
- Practice address
- 125 Hospital Drive
Watertown, WI 53098 - Phone
- (920) 262-4450
- NPI assigned
- Jun 17, 2006
- Last updated
- Mar 27, 2008
- 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 |
|---|---|---|---|---|
| Anesthesiologist Assistant | 367H00000X | 78920030 | WI | Primary |
Addresses
Primary practice location
125 Hospital Drive
Watertown, WI 53098
Mailing address
4555 West Schroeder Drive
Suite 170
Milwaukee, WI 53223
Phone (414) 365-3210
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 43379900 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- HHS exclusion list flag
- CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found.
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 78920030 | WI | MD | Anesthesiologist Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| West Coast Anesthesia PLLC | Past | Accepting new patients | |
| Southeast Anesthesiology | Past | Accepting new patients | |
| Kalamazoo Anesthesiology P C | Past | Accepting new patients |
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.
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- Kalamazoo, MI
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- Anesthesiology Physician
- Muskegon, MI
- NPI 1780603944
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150502400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1206576000000",
"number": "1871538744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4555 WEST SCHROEDER DRIVE",
"address_2": "SUITE 170",
"city": "MILWAUKEE",
"state": "WI",
"postal_code": "53223",
"telephone_number": "414-365-3210",
"fax_number": "414-365-3225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "125 HOSPITAL DRIVE",
"city": "WATERTOWN",
"state": "WI",
"postal_code": "53098",
"telephone_number": "920-262-4450"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARTZOG",
"first_name": "DIANE",
"middle_name": "L",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-06-17",
"last_updated": "2008-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "367H00000X",
"taxonomy_group": "",
"desc": "Anesthesiologist Assistant",
"state": "WI",
"license": "78920030",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43379900",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Watertown, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.