Individual provider Active NPI

Diane Perine Fontana, CRNA

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
National Provider Identifier
1114926110
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
182054 Issued in NC
Practice address
200 Hawthorne LN
Charlotte, NC 28204-2515
Phone
(704) 384-4239
Fax
(704) 384-5636
NPI assigned
Jul 20, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 14, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 2013006661 MO
Certified Registered Nurse Anesthetist 367500000X 182054 NC Primary

Addresses

Primary practice location

200 Hawthorne LN
Charlotte, NC 28204-2515

Mailing address

200 Hawthrone LN
Charlotte, NC 28204-2515
Phone (704) 384-4239

Other practice location 1

1 Barnes Jewish Hospital Plaza
Dept of Anesthesiology
St. Louis, MO 63110
Phone (800) 862-9980

Other identifiers 1

IdentifierTypeStateIssuer
8051588MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, SD2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130917000385 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 2062501679 Reassigns benefits to 2 organizations
I20240116000921 SD Practitioner - Certified Registered Nurse Anesthetist (Crna) 2062501679 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washington UniversityGroup PAC ID 9830008770, 2,968 clinicians

Practice addresses (Care Compare)

1 Barnes Jew Hosp PLZ
Saint Louis, MO 63110-1003
Phone (314) 747-3000

Hospital & facility affiliations

  • Barnes Jewish Hospital Hospital, Saint Louis, MO, CCN 260032

Merit-based Incentive Payment System (MIPS)

Final score
84.2 of 100Reported as group
Quality
71.6
Promoting interoperability
100
Improvement activities
40
Cost
75.75

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2013006661MOMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Sioux Falls Specialty Hospital, LLP CurrentSince Oct 31, 2023 Accepting new patients
Metro-West Anesthesia Group Inc Nurse Anesthetist, Certified Registered CurrentSince Jul 6, 2013 Accepting new patients
Washington University CurrentSince Jun 3, 2024 Accepting new patients
Washington University CurrentSince Jun 3, 2024 Accepting new patients
Sioux Falls Specialty Hospital, LLP CurrentSince Oct 31, 2023 Accepting new patients

Locations

400 S Woods Mill Rd
Ste 140
Chesterfield, MO 63017
Phone (314) 485-1101

2345 Dougherty Ferry Rd
Saint Louis, MO 63122
Phone (314) 821-5850

1 Barnes Jewish Hospital Plz
Saint Louis, MO 63110
Phone (314) 362-1700

1 Barnes Jewish Hospital Plz
#P
Saint Louis, MO 63110
Phone (618) 474-1074

615 S New Ballas Rd
Saint Louis, MO 63141
Phone (314) 251-4687

4960 Childrens Pl
Fl 2
Saint Louis, MO 63110
Phone (314) 362-1520

910 E 20th St
Sioux Falls, SD 57105
Phone (602) 338-7098

7600 S Minnesota Ave
Ste 202
Sioux Falls, SD 57108

Organizations & group practices 5

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1121817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1114926110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 HAWTHRONE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042515",
            "telephone_number": "704-384-4239",
            "fax_number": "704-384-5636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HAWTHORNE LN",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282042515",
            "telephone_number": "704-384-4239",
            "fax_number": "704-384-5636"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Barnes Jewish Hospital Plaza",
            "address_2": "Dept of Anesthesiology",
            "address_purpose": "LOCATION",
            "city": "St. Louis",
            "state": "MO",
            "postal_code": "63110",
            "country_code": "US",
            "telephone_number": "800-862-9980",
            "fax_number": "314-362-1185",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONTANA",
        "first_name": "DIANE",
        "middle_name": "PERINE",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-20",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2013006661",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "182054",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8051588",
            "state": "NC"
        }
    ],
    "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 May 14, 2024; 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.