NPIMap

Organization Active NPI

Four States Anesthesia Services LLC

  • Certified Registered Nurse Anesthetist
  • Joplin, MO
National Provider Identifier
1053382929
Registry record updated May 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
FOUR STATES ANESTHESIA SERVICES LLC
Practice address
1905 West 32ND Street
Suite #201
Joplin, MO 64804
Phone
(417) 206-7900
NPI assigned
Jan 30, 2006
Last updated
May 12, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2011

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

Authorized official

Name
Terri Susann Tracy, CRNANPI 1598735185
Title
Member
Phone
(417) 206-7900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X NU Primary

Addresses

Primary practice location

1905 West 32ND Street
Suite #201
Joplin, MO 64804

Mailing address

PO Box 388
Newton, KS 67114-0388
Phone (316) 281-3700

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, KS, OK3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20040216000537 MO Part B Supplier - Clinic/Group Practice 8729973284 Receives reassigned benefits from 35 practitioners
Practice locations: Branson, MO; Joplin, MO; Springfield, MO
O20100505000635 KS Part B Supplier - Clinic/Group Practice 8729973284 Receives reassigned benefits from 35 practitioners
Practice locations: Galena, KS
O20241227003152 OK Part B Supplier - Clinic/Group Practice 8729973284 Receives reassigned benefits from 17 practitioners
Practice locations: Grove, OK; Miami, OK

National Provider Directory

National Provider Directory

Locations

1531 E Bradford Pkwy
Ste 120
Springfield, MO 65804
Phone (417) 886-3900

Practitioners & affiliated clinicians

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 48

NPI Registry JSON

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

{
    "created_epoch": "1138579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1305158400000",
    "number": "1053382929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 388",
            "city": "NEWTON",
            "state": "KS",
            "postal_code": "671140388",
            "telephone_number": "316-281-3700",
            "fax_number": "316-282-4322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 WEST 32ND STREET",
            "address_2": "SUITE #201",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "64804",
            "telephone_number": "417-206-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR STATES ANESTHESIA SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-30",
        "last_updated": "2011-05-12",
        "status": "A",
        "authorized_official_last_name": "TRACY",
        "authorized_official_first_name": "TERRI",
        "authorized_official_middle_name": "SUSANN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "417-206-7900",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joplin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.