NPIMap

Individual provider Active NPI

Tyler G Higginson, CRNA

  • Certified Registered Nurse Anesthetist
  • Waupaca, WI
National Provider Identifier
1992878789
Registry record updated Nov 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3410-33 Issued in WI
Practice address
710 Riverside Dr
Waupaca, WI 54981-1941
Phone
(715) 256-3000
NPI assigned
Nov 17, 2006
Last updated
Nov 24, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R79716 SC
Certified Registered Nurse Anesthetist 367500000X 3410-33 WI Primary

Addresses

Primary practice location

710 Riverside Dr
Waupaca, WI 54981-1941

Mailing address

2109B E Capitol Dr Ste 1
Appleton, WI 54911-8726
Phone (920) 202-3371

Other identifiers 1

IdentifierTypeStateIssuer
011417052OtherSCDRIVERS LICENSE

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address thigginson43684@direct.myadvocateaurora.org
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070327000598 WI Practitioner - Certified Registered Nurse Anesthetist (Crna) 1052415213 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Association of Hospital Anesthesiologists SCGroup PAC ID 3476539875, 84 clinicians

Practice addresses (Care Compare)

800 Riverside Dr
Waupaca, WI 54981-1943
Phone (715) 258-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R79716SCMDCertified Registered Nurse Anesthetist
3410-33WIMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Thedacare Medical Center - Berlin, Inc. CurrentSince May 15, 2015 Accepting new patients
Association of Hospital Anesthesiologists SC CurrentSince Jun 1, 2020 Accepting new patients
Thedacare Medical Center - Berlin, Inc. Current Accepting new patients
Nurse Anesthesia Professional Services LLC Nurse Anesthetist, Certified Registered PastSince Dec 15, 2024 Accepting new patients

Locations

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

2109 E Capitol Dr
#B
Appleton, WI 54911
Phone (844) 693-1483

225 Memorial Dr
Berlin, WI 54923
Phone (920) 361-1313

736 Ford St
Kimberly, WI 54136

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

130 2nd St
#A107
Neenah, WI 54956

1405 Mill St
New London, WI 54961
Phone (920) 531-2000

100 Cty Road B
Shawano, WI 54166
Phone (715) 524-2161

800 Riverside Dr
Waupaca, WI 54981
Phone (715) 258-1000

Organizations & group practices 4

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.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1163721600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637712000000",
    "number": "1992878789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2109B E CAPITOL DR STE 1",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549118726",
            "telephone_number": "920-202-3371",
            "fax_number": "920-939-3827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 RIVERSIDE DR",
            "city": "WAUPACA",
            "state": "WI",
            "postal_code": "549811941",
            "telephone_number": "715-256-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HIGGINSON",
        "first_name": "TYLER",
        "middle_name": "G",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-17",
        "last_updated": "2021-11-24",
        "certification_date": "2021-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SC",
            "license": "R79716",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "3410-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVERS LICENSE",
            "identifier": "011417052",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "thigginson43684@direct.myadvocateaurora.org",
            "affiliation": "N",
            "address_1": "710 Riverside Dr",
            "city": "Waupaca",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549811941",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "710 Riverside Dr",
            "city": "Waupaca",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549811941",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Waupaca, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2021; 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.