Individual provider Active NPI

Andrew Joseph Proctor

  • Certified Registered Nurse Anesthetist
  • Canton, MI
National Provider Identifier
1952841637
Registry record updated Mar 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704267973 Issued in MI
Practice address
800 Pheasant Woods Drive
Canton, MI 48188-5224
Phone
(734) 812-1311
NPI assigned
Mar 1, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2017

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 4704267973 MI Primary

Addresses

Primary practice location

800 Pheasant Woods Drive
Canton, MI 48188-5224

Mailing address

800 Pheasant Woods Dr
Canton, MI 48188-5224
Phone (734) 812-1311

Other names 1

  • Mr. Andrew Joseph Proctor Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170509001103 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 4486931078 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2016
Medicare assignment
May accept Medicare assignment
Group practices
Northstar Anesthesia of Michigan III PLLCGroup PAC ID 7911325469, 561 clinicians
Sjmhs Anesthesia ServicesGroup PAC ID 7416053483, 103 clinicians

Practice addresses (Care Compare)

33155 Annapolis St
Wayne, MI 48184-2405
Phone (214) 687-0001

5301 E Huron River Dr
Ypsilanti, MI 48197-1051
Phone (734) 712-3456

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Huron Gastroenterology Associates PC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2021 Accepting new patients
Huron Gastroenterology Associates PC CurrentSince Jun 1, 2021 Accepting new patients
Sjmhs Anesthesia Services Nurse Anesthetist, Certified Registered CurrentSince May 1, 2013 Accepting new patients
Center for Digestive Care LLC CurrentSince May 1, 2021 Accepting new patients
Northstar Anesthesia of Michigan III PLLC Nurse Anesthetist, Certified Registered CurrentSince May 8, 2023 Accepting new patients
Sjmhs Anesthesia Services Current Accepting new patients
Sjmhs Anesthesia Services Nurse Anesthetist, Certified Registered CurrentSince May 1, 2013 Accepting new patients

Locations

2006 Hogback Rd
Ste 5A
Ann Arbor, MI 48105
Phone (734) 786-2317

620 Byron Rd
Howell, MI 48843
Phone (517) 545-5450

33155 Annapolis St
Wayne, MI 48184
Phone (734) 467-4042

5301 McAuley Dr
Ypsilanti, MI 48197
Phone (734) 712-7246

135 S Prospect St
Ypsilanti, MI 48198
Phone (734) 547-1060

5300 Elliott Dr
Ypsilanti, MI 48197
Phone (734) 434-6262

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 7

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": "1488326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488326400000",
    "number": "1952841637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 PHEASANT WOODS DR",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481885224",
            "telephone_number": "734-812-1311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 PHEASANT WOODS DRIVE",
            "city": "CANTON",
            "state": "MI",
            "postal_code": "481885224",
            "telephone_number": "734-812-1311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROCTOR",
        "first_name": "ANDREW",
        "middle_name": "JOSEPH",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-01",
        "last_updated": "2017-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704267973",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANDREW",
            "last_name": "PROCTOR",
            "middle_name": "JOSEPH",
            "prefix": "MR.",
            "credential": "CRNA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Canton, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2017; 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.