Active NPI
Robert C Brucker, C.R.N.A.
- Certified Registered Nurse Anesthetist
- Mount Shasta, CA
National Provider Identifier
1073582854
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 000255
- Practice address
- 914 Pine St
Mount Shasta, CA 96067-2143 - Phone
- (530) 926-6111
- Fax
- (530) 926-0517
- NPI assigned
- Mar 15, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 000255 | NV | Primary |
Addresses
Primary practice location
914 Pine St
Mount Shasta, CA 96067-2143
Mailing address
PO Box 1618
Fallon, NV 89407-1618
Phone (702) 419-0722
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1005070601 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000255 | NV | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anesthesia Associates, PS | Current | Accepting new patients | |
| Dignity Health | Past | Accepting new patients |
Locations
800 W 5th Ave
Spokane, WA 99204
Phone (509) 458-5800
Organizations & group practices 3
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.
-
- Anesthesiology Physician
- Spokane, WA
- NPI 1831143254
-
dba Whitman Hospital & Medical Center
- Critical Access Hospital
- Colfax, WA
- NPI 1922009448
-
dba Mercy Medical Center Redding
- General Acute Care Hospital
- Redding, CA
- NPI 1477671535
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142380800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1073582854",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1618",
"city": "FALLON",
"state": "NV",
"postal_code": "894071618",
"telephone_number": "702-419-0722"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "914 PINE ST",
"city": "MOUNT SHASTA",
"state": "CA",
"postal_code": "960672143",
"telephone_number": "530-926-6111",
"fax_number": "530-926-0517"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUCKER",
"first_name": "ROBERT",
"middle_name": "C",
"credential": "C.R.N.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "NV",
"license": "000255",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1005070601",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Mount Shasta, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.