Individual provider Active NPI

Jacob Ivan Hartig, CRNA

  • Certified Registered Nurse Anesthetist
  • Grand Rapids, MI
National Provider Identifier
1992047039
Registry record updated Jul 3, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4704267093 Issued in MI
Practice address
3333 Evergreen Dr NE
Suite 100
Grand Rapids, MI 49525-9493
Phone
(616) 364-4200
Fax
(616) 364-7347
NPI assigned
Mar 26, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 3, 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 4704267093 MI Primary

Addresses

Primary practice location

3333 Evergreen Dr NE
Suite 100
Grand Rapids, MI 49525-9493

Mailing address

3333 Evergreen Dr NE
Suite 100
Grand Rapids, MI 49525-9493
Phone (616) 364-4200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130827000548 MI Practitioner - Certified Registered Nurse Anesthetist (Crna) 3971746710 Reassigns benefits to 2 organizations
I20151207001417 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 3971746710 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Spectrum Health Primary Care PartnersGroup PAC ID 4587568647, 2,283 clinicians
Anesthesia Dynamics LLCGroup PAC ID 3779832530, 883 clinicians

Practice addresses (Care Compare)

100 Michigan Ave NE
Grand Rapids, MI 49503-2560

100 Michigan St NE RM
280 Corewell Health Medical Group West
Grand Rapids, MI 49503-2560
Phone (616) 267-0115

204 B E 19TH St
Panama City, FL 32405-4707
Phone (850) 769-7599

4444 Kalamazoo Ave SE
200 Corewell Health Medical Group West
Kentwood, MI 49508-4600
Phone (616) 391-5600

Hospital & facility affiliations

  • Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Spectrum Health Primary Care Partners Current Accepting new patients
Resource Anesthesiology Associates of Mi PC CurrentSince Jun 1, 2023 Accepting new patients
Wayne Lee MD Plastic Surgery PLLC CurrentSince Aug 11, 2016 Accepting new patients
Lakewood Ranch Anesthesia PL Nurse Anesthetist, Certified Registered CurrentSince Sep 7, 2019 Accepting new patients
Spectrum Health Primary Care Partners CurrentSince Oct 15, 2025 Accepting new patients
Anesthesia Dynamics LLC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2022 Accepting new patients
Fleming Island Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 10, 2023 Accepting new patients
Sunbelt Anesthesia Services, LLC Nurse Anesthetist, Certified Registered CurrentSince Jun 18, 2022 Accepting new patients
Quiescence Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 15, 2016 Accepting new patients
Sunbelt Visiting Primary Care LLC PastSince Jan 1, 2017 Accepting new patients

Locations

206 2nd St E
Bradenton, FL 34208
Phone (941) 745-7202

6015 Pointe West Blvd
Ste 101
Bradenton, FL 34209
Phone (941) 782-0101

1020 E Brandon Blvd
Ste 101
Brandon, FL 33511
Phone (813) 579-3369

665 Del Prado Blvd S
Cape Coral, FL 33990
Phone (239) 772-3636

6412 W Gulf To Lake Hwy
Crystal River, FL 34429
Phone (352) 563-0023

4571 Colonial Blvd
Ste 200
Fort Myers, FL 33966
Phone (239) 333-2050

8833 Perimeter Park Blvd
Ste 901
Jacksonville, FL 32216
Phone (904) 240-4777

7051 Southpoint Pkwy S
Jacksonville, FL 32216
Phone (904) 432-1521

8330 Lakewood Ranch Blvd
Lakewood Ranch, FL 34202
Phone (941) 666-8757

308 Palmetto St
New Smyrna Beach, FL 32168
Phone (386) 426-2565

1670 Eagle Harbor Pkwy
Ste B
Orange Park, FL 32003
Phone (904) 541-3048

1780 N Mills Ave
Orlando, FL 32803
Phone (407) 426-8484

204B E 19th St
Panama City, FL 32405
Phone (850) 769-7599

1501 Pasadena Ave S
South Pasadena, FL 33707
Phone (727) 341-7777

366 Beverly Ct
Fl Spgs
Spring Hill, FL 34606
Phone (352) 600-0220

100 Michigan St NE
Grand Rapids, MI 49503
Phone (616) 391-1680

4444 Kalamazoo Ave SE
Ste 200
Kentwood, MI 49508
Phone (616) 391-5600

826 W King St
Owosso, MI 48867
Phone (989) 720-2273

800 S Washington Ave
Saginaw, MI 48601
Phone (989) 776-8000

4599 Towne Centre Rd
Saginaw, MI 48604
Phone (989) 497-3000

200 Hemlock St
Tawas City, MI 48763
Phone (989) 362-0153

Interoperability endpoints

  • Direct secure messaging: jhartig603640@direct.hfhs.org

Organizations & group practices 10

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 2

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": "1364256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404345600000",
    "number": "1992047039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3333 EVERGREEN DR NE",
            "address_2": "SUITE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259493",
            "telephone_number": "616-364-4200",
            "fax_number": "616-364-7347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3333 EVERGREEN DR NE",
            "address_2": "SUITE 100",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495259493",
            "telephone_number": "616-364-4200",
            "fax_number": "616-364-7347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARTIG",
        "first_name": "JACOB",
        "middle_name": "IVAN",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-26",
        "last_updated": "2014-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MI",
            "license": "4704267093",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 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.