Individual provider Active NPI

Samuel Taylor, CRNA

  • Certified Registered Nurse Anesthetist
  • Albuquerque, NM
National Provider Identifier
1073051884
Registry record updated Feb 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
CRNA-01470 Issued in NM
Practice address
1720 Louisiana Blvd NE
Suite 401
Albuquerque, NM 87110-7022
Phone
(505) 260-4300
Fax
(505) 260-4371
NPI assigned
Feb 1, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 1, 2017

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 CRNA-01470 NM Primary

Addresses

Primary practice location

1720 Louisiana Blvd NE
Suite 401
Albuquerque, NM 87110-7022

Mailing address

1720 Louisiana Blvd NE
Suite 401
Albuquerque, NM 87110-7022
Phone (505) 260-4300

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201015001244 ID Practitioner - Certified Registered Nurse Anesthetist (Crna) 1254616469 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Albany Medical College of Union University, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Clinic LLCGroup PAC ID 1052217478, 313 clinicians

Practice addresses (Care Compare)

575 Pole Line Rd W
Twin Falls, ID 83301-9998
Phone (208) 814-9200

746 N College Rd
Twin Falls, ID 83301-3486

775 Pole Line Rd W
Twin Falls, ID 83301-5820

801 Pole Line Rd W
Twin Falls, ID 83301-5810

Hospital & facility affiliations

  • St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002

Merit-based Incentive Payment System (MIPS)

Final score
85.09 of 100Reported as group
Quality
77.1
Promoting interoperability
100
Improvement activities
40
Cost
73.19

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CRNA-01470NMMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Clinic LLC CurrentSince Sep 1, 2020 Accepting new patients

Locations

190 E Bannock St
Boise, ID 83712
Phone (208) 381-2378

746 N College Rd
Ste D
Twin Falls, ID 83301
Phone (208) 814-7230

Organizations & group practices 1

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": "1485907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485907200000",
    "number": "1073051884",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1720 LOUISIANA BLVD NE",
            "address_2": "SUITE 401",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871107022",
            "telephone_number": "505-260-4300",
            "fax_number": "505-260-4371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1720 LOUISIANA BLVD NE",
            "address_2": "SUITE 401",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871107022",
            "telephone_number": "505-260-4300",
            "fax_number": "505-260-4371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAYLOR",
        "first_name": "SAMUEL",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-01",
        "last_updated": "2017-02-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NM",
            "license": "CRNA-01470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 1, 2017; 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.