Individual provider Active NPI

Robert William Blankenship, CRNA

  • Certified Registered Nurse Anesthetist
  • Tulsa, OK
National Provider Identifier
1063987600
Registry record updated Apr 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
200198 Issued in OK
Practice address
6161 S Yale Ave
Tulsa, OK 74136-1902
Phone
(918) 494-0612
Fax
(918) 481-5170
NPI assigned
Oct 10, 2018
Last updated
Apr 29, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X AP140507 TX
Certified Registered Nurse Anesthetist 367500000X 200198 OK Primary
Registered Nurse 163W00000X 898076 TX

Addresses

Primary practice location

6161 S Yale Ave
Tulsa, OK 74136-1902

Mailing address

6839 S Canton Ave
Tulsa, OK 74136-3402
Phone (918) 494-0612

Other practice location 1

1400 8th Ave
Fort Worth, TX 76104-4110
Phone (817) 926-2544

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, OK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190226003058 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 4284973819 Reassigns benefits to 2 organizations
I20210122000082 OK Practitioner - Certified Registered Nurse Anesthetist (Crna) 4284973819 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northeastern Health SystemGroup PAC ID 1456255025, 105 clinicians
Integral Anesthesia LLCGroup PAC ID 9638461973, 159 clinicians

Practice addresses (Care Compare)

1400 E Downing St
Tahlequah, OK 74464-3324
Phone (918) 456-0641

1923 S Utica Ave
Tulsa, OK 74104-6520
Phone (919) 744-3131

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
898076TXMDRegistered Nurse
AP140507TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Osh Aai PLLC CurrentSince Oct 17, 2020 Accepting new patients
Northeastern Health System CurrentSince Apr 15, 2025 Accepting new patients
Northeastern Health System CurrentSince Apr 15, 2025 Accepting new patients
Northstar Anesthesia II PA Nurse Anesthetist, Certified Registered CurrentSince Feb 7, 2019 Accepting new patients
Integral Anesthesia, LLC Nurse Anesthetist, Certified Registered CurrentSince Apr 13, 2025 Accepting new patients
Northstar Anesthesia, PA Nurse Anesthetist, Certified Registered CurrentSince Feb 7, 2019 Accepting new patients

Locations

3029 W Main St
Jenks, OK 74037
Phone (918) 346-5002

1400 E Downing St
Tahlequah, OK 74464
Phone (918) 456-0641

1923 S Utica Ave
Tulsa, OK 74104
Phone (918) 744-2345

6839 S Canton Ave
Tulsa, OK 74136
Phone (918) 494-0612

11801 South Fwy
Burleson, TX 76028
Phone (817) 551-2738

7101 S Padre Island Dr
Corpus Christi, TX 78412
Phone (361) 761-1400

1400 8th Ave
Ft Worth, TX 76104
Phone (817) 922-1559

1401 8th Ave
Ft Worth, TX 76104
Phone (817) 334-2831

909 9th Ave
Ft Worth, TX 76104
Phone (817) 336-6060

1917 Ashland St
Houston, TX 77008
Phone (713) 861-6161

6200 W Parker Rd
Plano, TX 75093
Phone (972) 608-8000

Organizations & group practices 7

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.

Hospital & facility affiliations 5

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": "1539129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651190400000",
    "number": "1063987600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6839 S CANTON AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363402",
            "telephone_number": "918-494-0612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6161 S YALE AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741361902",
            "telephone_number": "918-494-0612",
            "fax_number": "918-481-5170"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1400 8th Ave",
            "address_purpose": "LOCATION",
            "city": "Fort Worth",
            "state": "TX",
            "postal_code": "761044110",
            "country_code": "US",
            "telephone_number": "817-926-2544",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLANKENSHIP",
        "first_name": "ROBERT",
        "middle_name": "WILLIAM",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-10",
        "last_updated": "2022-04-29",
        "certification_date": "2022-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "AP140507",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OK",
            "license": "200198",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "898076",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2022; 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.