Individual provider Active NPI

Vincent Cleveland David

  • Certified Registered Nurse Anesthetist
  • Wilkes Barre, PA
National Provider Identifier
1063259570
Registry record updated Jul 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
148206 Issued in PA
Practice address
575 N River St
Wilkes Barre, PA 18764-0999
Phone
(570) 829-8111
NPI assigned
Jul 11, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 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 148206 PA Primary

Addresses

Primary practice location

575 N River St
Wilkes Barre, PA 18764-0999

Mailing address

628 Prospect Ave Apt 3
Scranton, PA 18505-1842
Phone (917) 854-8125

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NY2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240808001614 PA Practitioner - Certified Registered Nurse Anesthetist (Crna) 1153868153 Reassigns benefits to 2 organizations
I20240925003957 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 1153868153 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Upmc Pinnacle Anesthesia Services LLCGroup PAC ID 1951662980, 252 clinicians

Practice addresses (Care Compare)

111 S Front St
Harrisburg, PA 17101-2010
Phone (717) 782-3282

1995 Technology Pkwy
Mechanicsburg, PA 17050-8522
Phone (717) 782-3282

Hospital & facility affiliations

  • Upmc Pinnacle Hospitals Hospital, Harrisburg, PA, CCN 390067

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
148206PAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Fpa Hospital Based Current Accepting new patients
Upmc Pinnacle Anesthesia Services, LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2025 Accepting new patients
Fpa Hospital Based CurrentSince Sep 30, 2024 Accepting new patients
Upmc Pinnacle Anesthesia Services, LLC CurrentSince Jan 1, 2025 Accepting new patients
360 Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2024 Accepting new patients
Fpa Hospital Based Nurse Anesthetist, Certified Registered CurrentSince Sep 30, 2024 Accepting new patients

Locations

1176 5th Ave
New York, NY 10029
Phone (212) 241-6237

409 S 2nd St
Ste 2F
Harrisburg, PA 17104
Phone (717) 231-8049

111 S Front St
Harrisburg, PA 17101
Phone (717) 782-3282

575 N River St
Wilkes Barre, PA 18764
Phone (570) 552-1300

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 7

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": "1720656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720656000000",
    "number": "1063259570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "628 PROSPECT AVE APT 3",
            "city": "SCRANTON",
            "state": "PA",
            "postal_code": "185051842",
            "telephone_number": "917-854-8125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 N RIVER ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187640999",
            "telephone_number": "570-829-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVID",
        "first_name": "VINCENT",
        "middle_name": "CLEVELAND",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-07-11",
        "last_updated": "2024-07-11",
        "certification_date": "2024-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "148206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 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.