Individual provider Active NPI

Mary Carol F Shurman, CRNA

  • Certified Registered Nurse Anesthetist
  • Columbus, OH
National Provider Identifier
1003817222
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
APRN.CRNA.02038 Issued in OH
Practice address
410 W 10TH Ave
Columbus, OH 43210-1240
Phone
(614) 293-8487
Fax
(614) 293-8153
NPI assigned
Aug 10, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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 APRN.CRNA.02038 OH Primary

Addresses

Primary practice location

410 W 10TH Ave
Columbus, OH 43210-1240

Mailing address

700 Ackerman Rd Ste 2120
Columbus, OH 43202-1559
Phone (614) 293-8487

Other practice location 1

500 S Cleveland Ave
Westerville, OH 43081-8971
Phone (614) 898-6659

Other identifiers 3

IdentifierTypeStateIssuer
XXXXX9049-00OtherOHOHIO BWC
0116663MedicaidOH
430040267OtherOHRR MCR

Other names 1

  • Mary Carol Fortunato Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100914000406 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 8224153374 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osu Observation Medicine, LLCGroup PAC ID 3375692270, 423 clinicians

Practice addresses (Care Compare)

410 W 10TH Ave
Columbus, OH 43210-1240
Phone (614) 293-8487

450 W 10TH Ave
Columbus, OH 43210-1240
Phone (614) 293-8000

452 W 10TH Ave
Columbus, OH 43210-1240
Phone (614) 293-8487

460 W 10TH Ave
Columbus, OH 43210-1240
Phone (614) 293-8487

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN.CRNA.02038OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Osu Observation Medicine, LLC CurrentSince Jul 1, 2022 Accepting new patients
Premier Anesthesia of Ohio LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 6, 2014 Accepting new patients

Locations

410 W 10th Ave
#N429
Columbus, OH 43210
Phone (614) 293-4705

793 W State St
Columbus, OH 43222
Phone (614) 234-1862

6001 E Broad St
Columbus, OH 43213
Phone (614) 224-6420

700 Ackerman Rd
Ste 570
Columbus, OH 43202
Phone (614) 293-2046

700 Ackerman Rd
Ste 2120
Columbus, OH 43202

410 W 10th Ave
Columbus, OH 43210
Phone (614) 293-5905

Organizations & group practices 2

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 4

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": "1123632000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1003817222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "700 ACKERMAN RD STE 2120",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432021559",
            "telephone_number": "614-293-8487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 W 10TH AVE",
            "city": "COLUMBUS",
            "state": "OH",
            "postal_code": "432101240",
            "telephone_number": "614-293-8487",
            "fax_number": "614-293-8153"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "500 S Cleveland Ave",
            "address_purpose": "LOCATION",
            "city": "Westerville",
            "state": "OH",
            "postal_code": "430818971",
            "country_code": "US",
            "telephone_number": "614-898-6659",
            "fax_number": "614-898-8631",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHURMAN",
        "first_name": "MARY CAROL",
        "middle_name": "F",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-10",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "APRN.CRNA.02038",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OHIO BWC",
            "identifier": "XXXXX9049-00",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0116663",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MCR",
            "identifier": "430040267",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "FORTUNATO",
            "middle_name": "CAROL",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Columbus, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2024; 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.