NPIMap

Individual provider Active NPI

Harold Richie Bandalan, CRNA

  • Certified Registered Nurse Anesthetist
  • Tyler, TX
National Provider Identifier
1063594638
Registry record updated May 1, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
671921 Issued in TX
Practice address
1000 S Beckham Ave
Tyler, TX 75701-1908
Phone
(903) 526-1068
Fax
(903) 593-4290
NPI assigned
Oct 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 1, 2013

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 671921 TX Primary

Addresses

Primary practice location

1000 S Beckham Ave
Tyler, TX 75701-1908

Mailing address

P.O. Box 8027
Tyler, TX 75711-8027
Phone (903) 526-1068

Other identifiers 5

IdentifierTypeStateIssuer
141704005MedicaidTX
141704006MedicaidTX
8649UAOtherTXBCBS
86184UOtherTXBCBS OF TEXAS
P00288096OtherTXPART B RAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20051219000593 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 4082636089 Reassigns benefits to 1 organization
I20160707002421 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 4082636089 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

100 Hospital Dr
Lebanon, MO 65536-9210
Phone (417) 553-6059

1235 E Cherokee St
Springfield, MO 65804-2203

2115 S Fremont Ave
3050 MC Infectious Disease Whiteside
Springfield, MO 65804-2236
Phone (417) 820-3905

3045 S National Ave
Springfield, MO 65804-4268

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
67192TXMDProfessional Counselor
6877CTMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Longview Medical Center LP CurrentSince Oct 6, 2014 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Feb 12, 2024 Accepting new patients
Longview Medical Center LP Nurse Anesthetist, Certified Registered CurrentSince Oct 6, 2014 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Feb 12, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Feb 12, 2024 Accepting new patients
University of Texas Health Science Center at Tyler-Facility-Physician Past Accepting new patients
East Texas Medical Center Past Accepting new patients

Locations

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

3801 S National Ave
Springfield, MO 65807
Phone (417) 269-4056

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

2901 4th St
Longview, TX 75605
Phone (281) 371-1800

Organizations & group practices 8

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 9

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": "1161302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1367366400000",
    "number": "1063594638",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 8027",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757118027",
            "telephone_number": "903-526-1068",
            "fax_number": "903-593-4290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S BECKHAM AVE",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011908",
            "telephone_number": "903-526-1068",
            "fax_number": "903-593-4290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANDALAN",
        "first_name": "HAROLD",
        "middle_name": "RICHIE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-20",
        "last_updated": "2013-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "671921",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "141704005",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "141704006",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8649UA",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF TEXAS",
            "identifier": "86184U",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PART B RAILROAD MEDICARE",
            "identifier": "P00288096",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2013; 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.