Individual provider Active NPI

Larry Heredia, CRNA

  • Certified Registered Nurse Anesthetist
  • Wilmington, DE
National Provider Identifier
1043302920
Registry record updated Dec 27, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
L60A00240 Issued in DE
Practice address
1600 Rockland Road
Wilmington, DE 19803-3607
Phone
(302) 651-4200
Fax
(302) 651-5365
NPI assigned
Sep 29, 2006
Last updated
Dec 27, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X L60A00240 DE Primary
Anesthesiologist Assistant 367H00000X L60A00240 DE

Addresses

Primary practice location

1600 Rockland Road
Wilmington, DE 19803-3607

Mailing address

P.O. Box 191
Rockland, DE 19723-0191
Phone (302) 651-4000

Other practice location 1

640 S State St
Dover, DE 19901-3530
Phone (300) 744-7088

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090831000482 DE Practitioner - Certified Registered Nurse Anesthetist (Crna) 4789746538 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Delaware Center for Digestive Care LLCGroup PAC ID 5890089353, 68 clinicians

Practice addresses (Care Compare)

537 Stanton Christiana Rd
Newark, DE 19713-2146
Phone (302) 225-2380

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
L60A00240DEMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of Delaware, LLC Nurse Anesthetist, Certified Registered CurrentSince Jun 28, 2021 Accepting new patients
Bayhealth Medical Center, Inc. CurrentSince Jan 20, 2020 Accepting new patients
Delaware Center for Digestive Care LLC CurrentSince Jun 15, 2023 Accepting new patients
Bayhealth Medical Center, Inc CurrentSince Jan 20, 2020 Accepting new patients

Locations

640 S State St
Dover, DE 19901
Phone (302) 744-4700

100 Wellness Way
Milford, DE 19963
Phone (302) 422-3311

4745 Ogletown Stanton Rd
Ste 134
Newark, DE 19713

537 Stanton Christiana Rd
Newark, DE 19713
Phone (302) 225-2380

701 N Clayton St
Wilmington, DE 19805
Phone (302) 421-4100

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577404800000",
    "number": "1043302920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 191",
            "city": "ROCKLAND",
            "state": "DE",
            "postal_code": "197230191",
            "telephone_number": "302-651-4000",
            "fax_number": "302-651-4945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 ROCKLAND ROAD",
            "city": "WILMINGTON",
            "state": "DE",
            "postal_code": "198033607",
            "telephone_number": "302-651-4200",
            "fax_number": "302-651-5365"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 S State St",
            "address_purpose": "LOCATION",
            "city": "Dover",
            "state": "DE",
            "postal_code": "199013530",
            "country_code": "US",
            "telephone_number": "300-744-7088",
            "fax_number": "302-744-6407",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HEREDIA",
        "first_name": "LARRY",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2019-12-27",
        "certification_date": "2019-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "DE",
            "license": "L60A00240",
            "primary": true
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "DE",
            "license": "L60A00240",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, DE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2019; 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.