NPIMap

Organization Active NPI

Greensboro Anesthesia Specialists Inc

  • Certified Registered Nurse Anesthetist
  • Chester, VA
National Provider Identifier
1073772612
Registry record updated Dec 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
GREENSBORO ANESTHESIA SPECIALISTS INC
Practice address
1714 E Hundred Rd Ste 104
Chester, VA 23836-3310
Phone
(888) 209-0305
Fax
(952) 442-3620
NPI assigned
Jun 9, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2021

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

Authorized official

Name
John Michael Nulty, CRNANPI 1437211737
Title
President
Phone
(336) 324-3116

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

1714 E Hundred Rd Ste 104
Chester, VA 23836-3310

Mailing address

400 10TH St E
Waconia, MN 55387-4552
Phone (888) 209-0305

Other practice location 1

520 N Elam Ave
Greensboro, NC 27403-1127
Phone (888) 209-0305

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20100106000273 VA Part B Supplier - Clinic/Group Practice 8729129226 Receives reassigned benefits from 16 practitioners
Practice locations: Chester, VA
O20101216000809 NC Part B Supplier - Clinic/Group Practice 8729129226 Receives reassigned benefits from 31 practitioners
Practice locations: Greensboro, NC

National Provider Directory

National Provider Directory

Locations

3480 Wake Forest Rd
Ste 204
Raleigh, NC 27609
Phone (919) 862-5093

101 Holbrook St
Ste A
Danville, VA 24541

Practitioners & affiliated clinicians

Practitioners 43

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 43

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1212969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639094400000",
    "number": "1073772612",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 10TH ST E",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553874552",
            "telephone_number": "888-209-0305",
            "fax_number": "952-442-3620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1714 E HUNDRED RD STE 104",
            "city": "CHESTER",
            "state": "VA",
            "postal_code": "238363310",
            "telephone_number": "888-209-0305",
            "fax_number": "952-442-3620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "520 N Elam Ave",
            "address_purpose": "LOCATION",
            "city": "Greensboro",
            "state": "NC",
            "postal_code": "274031127",
            "country_code": "US",
            "telephone_number": "888-209-0305",
            "fax_number": "952-442-3620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREENSBORO ANESTHESIA SPECIALISTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-09",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A",
        "authorized_official_last_name": "NULTY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-324-3116",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chester, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; 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.

Verify at the official NPI Registry.