Individual provider Active NPI

Estelle K McInnis, CRNA

  • Certified Registered Nurse Anesthetist
  • Stoneham, MA
National Provider Identifier
1063429553
Registry record updated Apr 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
118154 Issued in MA
Practice address
91 Montvale Avenue
Northshore Cataract & Laser Center
Stoneham, MA 02180
Phone
(781) 438-5995
NPI assigned
Aug 1, 2006
Last updated
Apr 16, 2008By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 16, 2008

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 118154 MA Primary

Addresses

Primary practice location

91 Montvale Avenue
Northshore Cataract & Laser Center
Stoneham, MA 02180

Mailing address

430 Bow Lake Rd
Northwood, NH 03261-3318
Phone (603) 942-8521

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
000000MAMDProsthodontist

Practice roles

OrganizationSpecialtyStatusNew patients
St. Lukes Surgical at the Villages, Inc CurrentSince Apr 1, 2016 Accepting new patients
Massachusetts Anesthesia Corporation Past Accepting new patients

Locations

43309 US Highway 19 N
Tarpon Springs, FL 34689
Phone (727) 938-2020

1050 Old Camp Rd
Ste 230
The Villages, FL 32162
Phone (352) 350-8484

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, 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": "1154390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208304000000",
    "number": "1063429553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 BOW LAKE RD",
            "city": "NORTHWOOD",
            "state": "NH",
            "postal_code": "032613318",
            "telephone_number": "603-942-8521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "91 MONTVALE AVENUE",
            "address_2": "NORTHSHORE CATARACT & LASER CENTER",
            "city": "STONEHAM",
            "state": "MA",
            "postal_code": "02180",
            "telephone_number": "781-438-5995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCINNIS",
        "first_name": "ESTELLE",
        "middle_name": "K",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-01",
        "last_updated": "2008-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MA",
            "license": "118154",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Stoneham, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.