Individual provider Active NPI

Jesse Travis

  • Certified Registered Nurse Anesthetist
  • Greeley, CO
National Provider Identifier
1083139117
Registry record updated Aug 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN.1619552 Issued in CO
Practice address
1801 16TH St
Greeley, CO 80631-5154
Phone
(970) 810-4819
Fax
(970) 810-4015
NPI assigned
Aug 9, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 9, 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 RN.1619552 CO Primary

Addresses

Primary practice location

1801 16TH St
Greeley, CO 80631-5154

Mailing address

4102 Carroway Seed Dr
Johnstown, CO 80534-8257

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, NE2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180108003086 CO Practitioner - Certified Registered Nurse Anesthetist (Crna) 2466711973 Reassigns benefits to 1 organization
I20220801001343 NE Practitioner - Certified Registered Nurse Anesthetist (Crna) 2466711973 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

601 W Leota St
Great Plains Health
North Platte, NE 69101-6525
Phone (308) 568-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN.1619552COMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
North Platte Surgery Center LLC Current Accepting new patients
Rocky Mountain State Anesthesia Providers CurrentSince Mar 1, 2018 Accepting new patients
Rocky Mountain State Anesthesia Providers CurrentSince Mar 1, 2018 Accepting new patients
North Platte Surgery Center Anesthesia, LLC Nurse Anesthetist, Certified Registered CurrentSince Mar 31, 2024 Accepting new patients
North Platte Nebraska Hospital Corporation CurrentSince Aug 8, 2022 Accepting new patients
North Platte Nebraska Hospital Corporation Current Accepting new patients

Locations

5890 W 13th St
Ste 102
Greeley, CO 80634
Phone (970) 348-0090

1801 16th St
Greeley, CO 80631
Phone (970) 352-4121

2000 Boise Ave
Loveland, CO 80538
Phone (970) 635-4071

601 W Leota St
North Platte, NE 69101
Phone (308) 534-2288

601 W Leota St
Ste 150
North Platte, NE 69101

621 W Francis St
North Platte, NE 69101
Phone (308) 534-8800

Interoperability endpoints

  • Direct secure messaging: jtravis406374@direct.nebraskamed.com

Organizations & group practices 6

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 2

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": "1502236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502236800000",
    "number": "1083139117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4102 CARROWAY SEED DR",
            "city": "JOHNSTOWN",
            "state": "CO",
            "postal_code": "805348257"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 16TH ST",
            "city": "GREELEY",
            "state": "CO",
            "postal_code": "806315154",
            "telephone_number": "970-810-4819",
            "fax_number": "970-810-4015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TRAVIS",
        "first_name": "JESSE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-08-09",
        "last_updated": "2017-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CO",
            "license": "RN.1619552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Greeley, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 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.