Active NPI
Carol Anne Bernicke, CRNA
- Certified Registered Nurse Anesthetist
- Ann Arbor, MI
National Provider Identifier
1962420745
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 4704162630
- Practice address
- 1500 East Medical Center Dr
Ann Arbor, MI 48109-0048 - Phone
- (734) 936-4280
- NPI assigned
- Jul 18, 2006
- 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 |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 4704162630 | MI | Primary |
Addresses
Primary practice location
1500 East Medical Center Dr
Ann Arbor, MI 48109-0048
Mailing address
3621 S State St 700 KMS Place
Attn Ellen Kayfes
Ann Arbor, MI 48108
Phone (734) 936-2047
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 4096180 | Medicaid | MI |
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
| License | State | Type | Specialty |
|---|---|---|---|
| 4704162630 | MI | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1962420745",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3621 S STATE ST 700 KMS PLACE",
"address_2": "ATTN ELLEN KAYFES",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "48108",
"telephone_number": "734-936-2047"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 EAST MEDICAL CENTER DR",
"city": "ANN ARBOR",
"state": "MI",
"postal_code": "481090048",
"telephone_number": "734-936-4280"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERNICKE",
"first_name": "CAROL",
"middle_name": "ANNE",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-07-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MI",
"license": "4704162630",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4096180",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ann Arbor, MI
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.