Individual provider Active NPI

Darrell C Herndon, CRNA

  • Certified Registered Nurse Anesthetist
  • Birmingham, AL
National Provider Identifier
1104807577
Registry record updated Jul 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1-040120 Issued in AL
Practice address
1201 11TH Ave S
Birmingham, AL 35205-3423
Phone
(205) 930-7296
Fax
(205) 930-7256
NPI assigned
Nov 10, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2010

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 1-040120 AL Primary

Addresses

Primary practice location

1201 11TH Ave S
Birmingham, AL 35205-3423

Mailing address

PO Box 55905
Birmingham, AL 35255-5905
Phone (205) 979-5882

Other identifiers 3

IdentifierTypeStateIssuer
P00729289OtherALRAILROAD MEDICARE
515-33846OtherALBC BS OF AL
051557594MedicaidAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060621000134 AL Practitioner - Certified Registered Nurse Anesthetist (Crna) 3173535879 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1-040120ALMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Alabama at Birmingham Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2010 Accepting new patients
University of Alabama at Birmingham CurrentSince Oct 1, 2010 Accepting new patients
University of Alabama at Birmingham Current Accepting new patients
University of Alabama Health Services Foundation, PC. CurrentSince Jun 1, 2017 Accepting new patients
Radiologist @ Uab Highlands Past Accepting new patients
Anesthesia Health Care Authority Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

619 19th St S
Birmingham, AL 35249

619 19th St S
Rm JT845
Birmingham, AL 35249
Phone (205) 934-7072

1201 11th Ave S
Birmingham, AL 35205
Phone (205) 930-7100

619 19th St S
Birmingham, AL 35233
Phone (205) 934-6405

Interoperability endpoints

  • Direct secure messaging: dherndon@direct.uabmedicine.org

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.

NPI Registry JSON

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

{
    "created_epoch": "1131580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1278028800000",
    "number": "1104807577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 55905",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352555905",
            "telephone_number": "205-979-5882",
            "fax_number": "205-979-1248"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 11TH AVE S",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352053423",
            "telephone_number": "205-930-7296",
            "fax_number": "205-930-7256"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNDON",
        "first_name": "DARRELL",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-10",
        "last_updated": "2010-07-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AL",
            "license": "1-040120",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00729289",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF AL",
            "identifier": "515-33846",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "051557594",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Birmingham, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2010; 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.