Individual provider Active NPI

Donald Camillo, C.R.N.A.

  • Certified Registered Nurse Anesthetist
  • Lewisville, TX
National Provider Identifier
1093896490
Registry record updated Aug 14, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
35211 Issued in TX
Practice address
1854 Lakepointe Dr
Lewisville, TX 75057-6442
Phone
(972) 315-1401
NPI assigned
Oct 18, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 14, 2008

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 35211 TX Primary

Addresses

Primary practice location

1854 Lakepointe Dr
Lewisville, TX 75057-6442

Mailing address

PO Box 292394
Lewisville, TX 75029-2394
Phone (972) 668-7460

Other identifiers 2

IdentifierTypeStateIssuer
DX62OtherTXBLUE CROSS / BLUE SHIELD
0071391-01MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110103000525 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 2365630597 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Endo Sedation LLC Nurse Anesthetist, Certified Registered CurrentSince Feb 16, 2023 Accepting new patients
Endo Sedation LLC Nurse Anesthetist, Certified Registered CurrentSince Feb 16, 2023 Accepting new patients
Endo Sedation LLC Nurse Anesthetist, Certified Registered Current Accepting new patients
Donald Camillo Crna PC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2010 Accepting new patients

Locations

1001 Surrey Ln
Flower Mound, TX 75022
Phone (817) 337-3671

180 Bear Creek Pkwy
Keller, TX 76248
Phone (817) 337-3671

1854 Lakepointe Dr
Lewisville, TX 75057
Phone (214) 306-4116

515 S Nolen Dr
Southlake, TX 76092
Phone (817) 912-1999

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218672000000",
    "number": "1093896490",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 292394",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750292394",
            "telephone_number": "972-668-7460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1854 LAKEPOINTE DR",
            "city": "LEWISVILLE",
            "state": "TX",
            "postal_code": "750576442",
            "telephone_number": "972-315-1401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAMILLO",
        "first_name": "DONALD",
        "name_prefix": "Mr.",
        "credential": "C.R.N.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-18",
        "last_updated": "2008-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "35211",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS / BLUE SHIELD",
            "identifier": "DX62",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0071391-01",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewisville, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2008; 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.