NPIMap

Individual provider Active NPI

Edelrose Fortea Bacanto, CRNA

  • Certified Registered Nurse Anesthetist
  • Fayetteville, NC
National Provider Identifier
1093368086
Registry record updated Jun 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
6389 Issued in NC
Practice address
1638 Owen Dr
Fayetteville, NC 28304-3424
Phone
(805) 509-7556
NPI assigned
Jul 19, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2025

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 6389 NC Primary

Addresses

Primary practice location

1638 Owen Dr
Fayetteville, NC 28304-3424

Mailing address

2629 Edmonton Rd
Fayetteville, NC 28304-3768

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200625001974 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 7315369097 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cumberland County Hospital System Inc 581 clinicians

Practice addresses (Care Compare)

1638 Owen Dr
Fayetteville, NC 28304-3424
Phone (910) 615-5610

Hospital & facility affiliations

  • Cape Fear Valley Medical Center Hospital, Fayetteville, NC, CCN 340028

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Cumberland County Hospital System Inc Anesthesiology CurrentSince Jun 23, 2020 Accepting new patients
Cumberland County Hospital System Inc CurrentSince Jun 23, 2020 Accepting new patients
Cumberland County Hospital System Inc Current Accepting new patients

Locations

1638 Owen Dr
Fayetteville, NC 28304
Phone (910) 609-5610

Organizations & group practices 11

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 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749772800000",
    "number": "1093368086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2629 EDMONTON RD",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043768"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1638 OWEN DR",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283043424",
            "telephone_number": "805-509-7556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACANTO",
        "first_name": "EDELROSE",
        "middle_name": "FORTEA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-19",
        "last_updated": "2025-06-13",
        "certification_date": "2025-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "6389",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 13, 2025; 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.