Individual provider Active NPI

Charles David Lummus, CRNA

  • Certified Registered Nurse Anesthetist
  • Texarkana, TX
National Provider Identifier
1124026000
Registry record updated Jul 26, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
244601 Issued in TX
Practice address
4100 Summerhill Rd
Texarkana, TX 75503-2732
Phone
(903) 735-9802
Fax
(903) 735-9806
NPI assigned
Jul 13, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 26, 2014

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 244601 TX Primary

Addresses

Primary practice location

4100 Summerhill Rd
Texarkana, TX 75503-2732

Mailing address

4100 Summerhill Rd
Texarkana, TX 75503-2732
Phone (903) 735-9802

Other identifiers 4

IdentifierTypeStateIssuer
133803701MedicaidAR
109671103MedicaidTX
89557COtherTXBLUE CROSS
97890OtherARBLUE CROSS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110330000908 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 1456534338 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1981
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergenchealth PLLCGroup PAC ID 1355606641, 1,037 clinicians

Practice addresses (Care Compare)

5404 Summerhill Rd
Texarkana, TX 75503-4607
Phone (903) 793-4872

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
33214TXMDSchool Psychologist
244601TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Collom & Carney Clinic Association Current Accepting new patients
Youngs Professional Services LLC Nurse Anesthetist, Certified Registered CurrentSince Dec 2, 2019 Accepting new patients
Northstar Anesthesia, PA Nurse Anesthetist, Certified Registered CurrentSince Jul 7, 2020 Accepting new patients
Emergenchealth PLLC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2021 Accepting new patients

Locations

909 9th Ave
Ft Worth, TX 76104
Phone (817) 336-6060

1917 Ashland St
Houston, TX 77008
Phone (713) 861-6161

6200 W Parker Rd
Plano, TX 75093
Phone (972) 608-8000

7400 Barlite Blvd
San Antonio, TX 78224
Phone (210) 921-2000

1305 Wonder World Dr
Ste 105
San Marcos, TX 78666
Phone (512) 353-8161

1000 Pine St
Texarkana, TX 75501
Phone (903) 798-7365

5002 Cowhorn Creek Rd
Texarkana, TX 75503
Phone (903) 614-3008

5404 Summerhill Rd
Texarkana, TX 75503
Phone (903) 792-3773

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": "1121212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1406332800000",
    "number": "1124026000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 SUMMERHILL RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032732",
            "telephone_number": "903-735-9802",
            "fax_number": "903-735-9806"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4100 SUMMERHILL RD",
            "city": "TEXARKANA",
            "state": "TX",
            "postal_code": "755032732",
            "telephone_number": "903-735-9802",
            "fax_number": "903-735-9806"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LUMMUS",
        "first_name": "CHARLES",
        "middle_name": "DAVID",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-13",
        "last_updated": "2014-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "244601",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "133803701",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "109671103",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "89557C",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "97890",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Texarkana, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2014; 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.