Individual provider Active NPI

Paul Derek Street, CRNA

  • Certified Registered Nurse Anesthetist
  • Greenville, SC
National Provider Identifier
1003136862
Registry record updated Jan 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
APRN4210 Issued in SC
Practice address
7 Independence PT Ste 300
Greenville, SC 29615-4569
Phone
(864) 522-3700
Fax
(864) 522-3705
NPI assigned
Jun 3, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 28, 2022

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 APRN4210 SC Primary

Addresses

Primary practice location

7 Independence PT Ste 300
Greenville, SC 29615-4569

Mailing address

300 E McBee Ave FL 4
Greenville, SC 29601-2842
Phone (864) 522-8603

Other practice location 1

5 Richland Medical Park Dr
Columbia, SC 29203-6863
Phone (803) 434-7000

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20101004000704 SC Practitioner - Certified Registered Nurse Anesthetist (Crna) 6204028681 Reassigns benefits to 2 organizations
I20231228003850 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 6204028681 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Physician Solutions of North Florida LLCGroup PAC ID 5597066001, 280 clinicians

Practice addresses (Care Compare)

449 W 23Rd St
Panama City, FL 32405-4507
Phone (954) 939-5000

Hospital & facility affiliations

  • HCA Florida Gulf Coast Hospital Hospital, Panama City, FL, CCN 100242

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN4210SCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Under Anesthesia CurrentSince Jul 21, 2020 Accepting new patients
Anesthesia Physician Solutions of North Florida, LLC CurrentSince Nov 14, 2023 Accepting new patients
Anesthesia Physician Solutions of North Florida, LLC Nurse Anesthetist, Certified Registered Current Accepting new patients
Prisma Health-Midlands Current Accepting new patients
Anesthesia Physician Solutions of North Florida, LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 14, 2023 Accepting new patients
Jay Godines, LLC Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

1000 Mar Walt Dr
Ft Walton Bch, FL 32547
Phone (850) 374-9610

449 W 23rd St
Panama City, FL 32405
Phone (850) 747-7900

325 Cypress Pkwy
Poinciana, FL 34759
Phone (407) 530-2000

106 Ellett Rd
Chapin, SC 29036
Phone (803) 941-8096

5 Richland Medical Park Dr
Columbia, SC 29203
Phone (803) 434-2168

1330 Taylor St
Columbia, SC 29201
Phone (803) 296-5137

5 Richland Medical Park Dr
Ste 470
Columbia, SC 29203

300 E McBee Ave
Fl 4
Greenville, SC 29601
Phone (864) 522-8615

5 Memorial Medical Ct
Greenville, SC 29605
Phone (864) 272-3409

420 W Wesmark Blvd
Sumter, SC 29150
Phone (803) 469-4402

Organizations & group practices 6

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 1

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": "1275523200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643328000000",
    "number": "1003136862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 E MCBEE AVE FL 4",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296012842",
            "telephone_number": "864-522-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7 INDEPENDENCE PT STE 300",
            "city": "GREENVILLE",
            "state": "SC",
            "postal_code": "296154569",
            "telephone_number": "864-522-3700",
            "fax_number": "864-522-3705"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5 Richland Medical Park Dr",
            "address_purpose": "LOCATION",
            "city": "Columbia",
            "state": "SC",
            "postal_code": "292036863",
            "country_code": "US",
            "telephone_number": "803-434-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "STREET",
        "first_name": "PAUL",
        "middle_name": "DEREK",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-06-03",
        "last_updated": "2022-01-28",
        "certification_date": "2022-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SC",
            "license": "APRN4210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenville, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2022; 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.