Individual provider Active NPI

Lindsey Clendenin Kutlick, R.N

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
National Provider Identifier
1104129535
Registry record updated Dec 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
202417 Issued in NC
Practice address
1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone
(704) 355-2000
NPI assigned
Dec 7, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 202417 NC
Certified Registered Nurse Anesthetist 367500000X 202417 NC Primary

Addresses

Primary practice location

1000 Blythe Blvd
Charlotte, NC 28203-5812

Mailing address

5201 Jupiter Hills CT
Charlotte, NC 28277-2513
Phone (704) 877-7760

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191001001868 SC Practitioner - Certified Registered Nurse Anesthetist (Crna) 1951582584 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Charleston Gastroenterology SpecialistsGroup PAC ID 3173437472, 49 clinicians

Practice addresses (Care Compare)

1962 Charlie Hall Blvd
Charleston, SC 29414-5837
Phone (843) 722-8000

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours St. Francis Xavier Hospital, Inc. Nurse Anesthetist, Certified Registered CurrentSince Jul 5, 2022 Accepting new patients
Atlantic Coast Anesthesia Services P.C. Nurse Anesthetist, Certified Registered CurrentSince Aug 28, 2023 Accepting new patients
Bon Secours St Francis Xavier Hospital, Inc. Current Accepting new patients
Coastal Anesthesia Associates, LLC CurrentSince Jul 1, 2020 Accepting new patients
Charleston Gastroenterology Specialists CurrentSince Nov 1, 2023 Accepting new patients
Bon Secours St. Francis Xavier Hospital, Inc. CurrentSince Jul 5, 2022 Accepting new patients
Charleston Gastroenterology Specialists CurrentSince Nov 1, 2023 Accepting new patients

Locations

2095 Henry Tecklenburg Dr
Charleston, SC 29414
Phone (843) 402-1037

1962 Charlie Hall Blvd
Charleston, SC 29414
Phone (803) 722-8000

423 Barony St
Moncks Corner, SC 29461

1021 Cipriana Dr
Ste 100
Myrtle Beach, SC 29572
Phone (843) 449-7885

130 Edge St
Summerville, SC 29486
Phone (843) 628-5816

2001 2nd Ave
Ste 101
Summerville, SC 29486
Phone (843) 722-8000

Organizations & group practices 7

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": "1291680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575936000000",
    "number": "1104129535",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 JUPITER HILLS CT",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282772513",
            "telephone_number": "704-877-7760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-355-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KUTLICK",
        "first_name": "LINDSEY",
        "middle_name": "CLENDENIN",
        "credential": "R.N",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-07",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "202417",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "202417",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2019; 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.