MR. JACK PHILIP NICKERSON CRNA
NPI 1447262548
Nurse Anesthetist, Certified Registered in Grand Rapids, MI
NPI Status: Active since August 13, 2006
Contact Information
3333 EVERGREEN DR NE
GRAND RAPIDS, MI
ZIP 49525
Phone: (616) 364-4200
Fax: (616) 364-7347
- Individual
- Male
- Nurse Anesthetist, Certified Registered
About JACK NICKERSON
This page provides the complete NPI Profile along with additional information for Jack Nickerson, a provider established in Grand Rapids, Michigan with a medical specialization in Nurse Anesthetist, Certified Registered. The healthcare provider is registered in the NPI registry with number 1447262548 assigned on August 2006. The practitioner's primary taxonomy code is 367500000X with license number 4704234290 (MI). The provider is registered as an individual and his NPI record was last updated 15 years ago.
- NPI
- 1447262548
- Provider Name
- MR. JACK PHILIP NICKERSON CRNA
- Gender
- Male
- Entity Type
- Individual
- Location Address
- 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525
- Location Phone
- (616) 364-4200
- Location Fax
- (616) 364-7347
- Mailing Address
- 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525
- Mailing Phone
- (616) 364-4200
- Mailing Fax
- (616) 364-7347
- Is Sole Proprietor?
- No
- Enumeration Date
- 08-13-2006
- Last Update Date
- 08-30-2010
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nurse Anesthetist, Certified Registered
- Taxonomy Code
- 367500000X
- Type
- Physician Assistants & Advanced Practice Nursing Providers
- License No.
- 4704234290
- License State
- MI
- Taxonomy Description
- (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
Specific plan information not avaialable, please contact the provider to verify if your insurance plan is accepted.
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
Additional Identifiers
The NPI Enumerator encourages providers to submit additional identifiers with their NPI application although the submission of this information is optional. The additional identifier(s) section includes other numbers or codes currently or formerly used as an identifier for the provider by other public healthcare entities. The identifiers may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
| Identifier | Type / Code | Identifier State | Identifier Issuer |
|---|---|---|---|
| S29670 | MEDICARE UPIN (02) | ||
| 4612272 | MEDICAID (05) | MI | |
| M73860027 | MEDICARE ID-TYPE UNSPECIFIED (04) |
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 4 | 4 | 7 | 2 | 6 | 2 | 5 | 4 | 8 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 4 | 8 | 7 | 4 | 6 | 4 | 5 | 8 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 4 + 8 + 7 + 4 + 6 + 4 + 5 + 8 + 24 = 72 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 80 - 72 = 8 | 8 | ||||||||
The NPI number 1447262548 is valid because the calculated check digit 8 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 20 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1386622983 | DR. MARY MARTHA APPELT MD Individual | Anesthesiology | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1114907284 | DR. TODD A EMERY MD Individual | Anesthesiology | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1780664656 | DR. EDUARDO ORTIZ JR. MD Individual | Anesthesiology | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1780664078 | DR. SUSANNE GELBKE PAREKH MD Individual | Anesthesiology | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1265406235 | DR. DAVID L DULL MD Individual | Anesthesiology | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1992768659 | DR. RALPH T WALSH DO Individual | Anesthesiology | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1881708717 | MS. JULIA A NOORDEWIER CRNA Individual | Nurse Anesthetist, Certified Registered | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1083720106 | MS. ELIZABETH ANN TALSMA CRNA Individual | Nurse Anesthetist, Certified Registered | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1588772370 | MS. CAROLINE WALKER BLAKE CRNA Individual | Nurse Anesthetist, Certified Registered | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1053596387 | DR. VIVIAN NNENNA ONYEWUCHE M.D. Individual | Anesthesiology | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1831325786 | MRS. JOAN JANENE CASLER CRNA Individual | Nurse Anesthetist, Certified Registered | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1093946352 | MS. TRACY MARIE MAAS CRNA Individual | Nurse Anesthetist, Certified Registered | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1568799815 | KATHY JEAN LEE NP Individual | Nurse Practitioner | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1568791317 | MS. MARY ELIZABETH WHITE RN Individual | Registered Nurse (Pain Management) | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1417286394 | MS. DENISE ANN GEBOTT RN Individual | Registered Nurse (Pain Management) | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1508181561 | MS. BARBARA ANNE JOHNSON RN Individual | Registered Nurse (Pain Management) | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1356662191 | MS. JOANNE ELIZABETH DECKER RN Individual | Registered Nurse | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1528363926 | MS. TIMBERLY KAY DETERS RN Individual | Registered Nurse | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1639474083 | MS. JULIE KAYE OLMSTEAD RN Individual | Registered Nurse | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
| 1831494285 | MS. DEBRA SUE VANDERMAAS RN Individual | Registered Nurse | 3333 EVERGREEN DR NE GRAND RAPIDS, MI 49525 (616) 364-4200 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1447262548, enumerated in the NPI registry as an "individual" on August 13, 2006
The provider is located at 3333 Evergreen Dr Ne Grand Rapids, Mi 49525 and the phone number is (616) 364-4200
The provider's speciality is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X
The provider might be accepting Accepts: Medicare and Medicaid. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
This NPI record was last updated on August 13, 2006. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
NPI Profile data is regularly updated with the latest NPI registry information, if you would like to update or remove your NPI Profile in this website please contact us.