NPIMap

Organization Active NPI

Baec Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Castro Valley, CA
National Provider Identifier
1114446291
Registry record updated Sep 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
BAEC ANESTHESIA LLC
Practice address
20998 Redwood Rd
Castro Valley, CA 94546-5918
Phone
(510) 538-9900
NPI assigned
Sep 11, 2017
Last updated
Sep 16, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2020

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

Authorized official

Name
Dale W Polley Jr.
Title
Director
Phone
(615) 843-4102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

20998 Redwood Rd
Castro Valley, CA 94546-5918

Mailing address

401 Commerce St Ste 600
Nashville, TN 37219-2518
Phone (615) 843-4102

Other practice location 1

20400 Lake Chabot Rd Ste 201
Castro Valley, CA 94546-5315
Phone (510) 538-9900

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171103002022 CA Part B Supplier - Clinic/Group Practice 7214293430 Receives reassigned benefits from 11 practitioners
Practice locations: Castro Valley, CA

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1600214400000",
    "number": "1114446291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 COMMERCE ST STE 600",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372192518",
            "telephone_number": "615-843-4102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20998 REDWOOD RD",
            "city": "CASTRO VALLEY",
            "state": "CA",
            "postal_code": "945465918",
            "telephone_number": "510-538-9900"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20400 Lake Chabot Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Castro Valley",
            "state": "CA",
            "postal_code": "945465315",
            "country_code": "US",
            "telephone_number": "510-538-9900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BAEC ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-11",
        "last_updated": "2020-09-16",
        "certification_date": "2020-09-16",
        "status": "A",
        "authorized_official_last_name": "POLLEY",
        "authorized_official_first_name": "DALE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "615-843-4102",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Castro Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2020; 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.