MICHAEL INGERSOLL – Certified Registered Nurse Anesthetist, NPI 1902125289

MICHAEL INGERSOLL is a healthcare provider. based in Kenosha, Wisconsin. specializing in CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA). They hold a License No. 15311430 (WI). The NPI Number for MICHAEL INGERSOLL is 1902125289

Main info

Male
Sole Proprietor
16 Years Of Experience
Accepts Medicare Assignment
Name
MICHAEL INGERSOLL
NPI
1902125289
Phone
Not provided
Address
3302 56TH AVE UNIT 203
Enumeration Date
25 May 2010
Last Update Date
28 August 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8015856387
Graduation Year
2010 (16 years ago)
PAC ID
0648284281
Group Practice PAC ID
0941525273
Professional Enrollment ID
I20220810001316
Address ID
UT841320100SA50XXXDRXX400

Contacts

Secure Messaging
MINGERSOLL588468@DIRECT.MED.UTAH.EDU
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience56
Completeness85
Years active:16State licenses:1Other namesUpdated within 12 months

512 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in OR

Provider Addresses for MICHAEL INGERSOLL

  • 3302 56TH AVE UNIT 203

    KENOSHA, WI 531444908

    Phone:

    Type: Mailing

  • 3181 SW SAM JACKSON PARK RD

    PORTLAND, OR 972393011

    Phone: (503) 494-8014

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2022-08-10

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20220810001316ICertified Registered Nurse Anesthetist (Crna)UTTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
00142Anesthesia for lens surgery6060$0
00140Anesthesia for other procedure on eye2320$0
00145Anesthesia for retinal surgery1313$0
View full utilization report →

Insurance plans in this area (ZIP 53144)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 0941525273View full group profile
NameSpecialtyState
-UT
-UT
Emergency MedicineCO
-UT
A N E S T H E S I O L O G YUT
Physician AssistantUT
-IL
Plastic And Reconstructive SurgeryOH
Physician AssistantCA
A N E S T H E S I O L O G YUT

Reviews

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Frequently asked questions

How do I look up MICHAEL INGERSOLL by NPI?
Use NPI 1902125289 when you need to reference MICHAEL INGERSOLL in forms, claims, or directories.
Is MICHAEL INGERSOLL active in the national directory?
MICHAEL INGERSOLL's public NPI profile is in an active state.
Does MICHAEL INGERSOLL list a primary specialty?
If you are matching referrals, note Certified Registered Nurse Anesthetist for MICHAEL INGERSOLL. Clinical services aligned with this taxonomy classification.
Does MICHAEL INGERSOLL practice in Wisconsin?
You will see Kenosha, Wisconsin on file for MICHAEL INGERSOLL alongside any extra practice locations.
What if Kenosha, Wisconsin seems incomplete?
Street-level detail can be omitted — open the full address list for this NPI.

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