Individual provider Active NPI

Rebecca Mooberry, CRNA

  • Certified Registered Nurse Anesthetist
  • Nashville, TN
National Provider Identifier
1053501015
Registry record updated Jun 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
077695 Issued in NC
Practice address
20 Burton Hills Blvd
Suite 500
Nashville, TN 37215-6197
Phone
(615) 685-1283
Fax
(615) 665-0755
NPI assigned
Jul 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2012

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 077695 NC Primary

Addresses

Primary practice location

20 Burton Hills Blvd
Suite 500
Nashville, TN 37215-6197

Mailing address

20 Burton Hills Blvd
Suite 500
Nashville, TN 37215-6197
Phone (615) 685-1283

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070904000574 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 0648363846 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Anesthesiology Associates PAGroup PAC ID 3971566761, 218 clinicians

Practice addresses (Care Compare)

1918 Randolph Rd
Suite 740
Charlotte, NC 28207-1167
Phone (704) 316-0810

Hospital & facility affiliations

  • North Carolina Specialty Hospital Hospital, Durham, NC, CCN 340049

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
077695NCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Anesthesiology Associates, P.a. CurrentSince Apr 18, 2023 Accepting new patients
Regional Anesthesia, PLLC CurrentSince Jul 1, 2015 Accepting new patients

Locations

1918 Randolph Rd
Ste 740
Charlotte, NC 28207
Phone (704) 316-0810

131 Providence Rd
Ste 200
Charlotte, NC 28207
Phone 70474958001101

3643 N Roxboro St
Durham, NC 27704
Phone (919) 470-6186

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 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": "1185408000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1340841600000",
    "number": "1053501015",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 BURTON HILLS BLVD",
            "address_2": "SUITE 500",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156197",
            "telephone_number": "615-685-1283",
            "fax_number": "615-665-0755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20 BURTON HILLS BLVD",
            "address_2": "SUITE 500",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156197",
            "telephone_number": "615-685-1283",
            "fax_number": "615-665-0755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOOBERRY",
        "first_name": "REBECCA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-26",
        "last_updated": "2012-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "077695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2012; 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.