Individual provider Active NPI

Michael A Huck, CRNA

  • Certified Registered Nurse Anesthetist
  • Chesterfield, MO
National Provider Identifier
1881696706
Registry record updated Oct 30, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
086233 Issued in MO
Practice address
17050 Baxter Rd
Chesterfield Surgery Ctr. - Suite 110
Chesterfield, MO 63005-1422
Phone
(636) 537-0122
Fax
(636) 537-0480
NPI assigned
Aug 11, 2005
Last updated
Oct 30, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 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 086233 MO Primary

Addresses

Primary practice location

17050 Baxter Rd
Chesterfield Surgery Ctr. - Suite 110
Chesterfield, MO 63005-1422

Mailing address

351 Consort Dr
Ballwin, MO 63011-4439
Phone (636) 200-4242

Other identifiers 1

IdentifierTypeStateIssuer
912801057MedicaidMO

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)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
086233MOMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Anesthesia LTD Past Accepting new patients
Acuity Anesthesiology LLC Past Accepting new patients
Robert H and Teresita S Petty Past Accepting new patients
Physician Anesthesia Services, LLC Past Accepting new patients
Mason Ridge Ambulatory Surgery Center LP Past Accepting new patients

Organizations & group practices 5

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193702400000",
    "number": "1881696706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "351 CONSORT DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630114439",
            "telephone_number": "636-200-4242",
            "fax_number": "636-200-4243"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17050 BAXTER RD",
            "address_2": "CHESTERFIELD SURGERY CTR. - SUITE 110",
            "city": "CHESTERFIELD",
            "state": "MO",
            "postal_code": "630051422",
            "telephone_number": "636-537-0122",
            "fax_number": "636-537-0480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUCK",
        "first_name": "MICHAEL",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2007-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "086233",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "912801057",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chesterfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.