JEFFERY P ANTONISSEN CRNA
NPI 1760494512
Nurse Anesthetist, Certified Registered in Green Bay, WI

Q: What is Jeffery Antonissen's NPI number?

The NPI number for Jeffery Antonissen is 1760494512. It was assigned to this individual provider in the NPPES registry on August 12, 2006.

Q: What is Jeffery Antonissen's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Active since August 12, 2006Accepts Medicare Assignment

2845 GREENBRIER RD, GREEN BAY, WI 54311(920) 288-3388(920) 288-4863 Get Directions Write a Review

NPPES record last updated: April 21, 2026. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Apr 21, 2026, Apr 9, 2024, May 20, 2022 (3 updates tracked since 2022).

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About Jeffery P Antonissen Crna NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JEFFERY P ANTONISSEN CRNA (NPI 1760494512) is an individual nurse anesthetist, certified registered in Green Bay, Wisconsin, licensed in Wisconsin (113583) and active in the NPI registry since August 2006. He is affiliated with Aurora Baycare Medical Ctr and is a graduate of Other (1998).

NPPES Registry Identity

NPI1760494512

Entity TypeIndividualMale

Primary Taxonomy367500000X

Provider Legal NameJEFFERY P ANTONISSENCredential: CRNA

Location Address2845 GREENBRIER RDGreen Bay, WI 54311-6519

Mailing Address1035 Kepler DrGreen Bay, WI 54311-8320 · (920) 490-9046 · Fax (920) 405-8005

Phone(920) 288-3388

Fax(920) 288-4863

Sole ProprietorNo

Medical School CMSOtherGraduated 1998

Enumeration DateAugust 12, 2006

Last NPPES UpdateApril 21, 20263 updates tracked since enumeration

NPPES CertifiedApril 21, 2026

✔ NPI 1760494512 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code367500000X

License✔ Licensed in WI · 113583

Definition

(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.

2845 GREENBRIER RD, Green Bay, WI 54311

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Other Identifiers 4

Medicaid104521249MI

Medicaid104521230MI

Medicaid43399100WI

OtherP00033987WI · Railroad

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include CareSource (Common Ground Healthcare).Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jeffery P Antonissen Crna is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID8628110368

PECOS Enrollment IDI20100119000648

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Aurora Baycare Medical Ctr

Acute Care Hospitals · Green Bay, WI

5/5 CMS rating

OwnershipProprietary

CMS Certification Number520193

Location2845 Greenbrier RdGreen Bay, WI 54311 · Brown County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 54311 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$123.69 typical visit price

range $53.90 – $163.24

Typical copayment $30.92 (range $13.47 – $40.81)

Most-billed visit code 99204

Established Patient

$67.37 typical visit price

range $17.40 – $133.76

Typical copayment $16.84 (range $4.35 – $33.44)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AMRITHA CHANDRAHASA KARKERA M.D.

Internal Medicine (Hematology & Oncology)