Individual provider Active NPI

Cassidy Runyon

  • Certified Registered Nurse Anesthetist
  • Charleston, WV
National Provider Identifier
1134859036
Registry record updated Nov 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
116456 Issued in WV
Practice address
3200 Maccorkle Ave SE
Charleston, WV 25304-1227
Phone
(304) 388-5432
NPI assigned
Jun 14, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2023

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 116456 WV Primary
Registered Nurse 163W00000X 100222 WV

Addresses

Primary practice location

3200 Maccorkle Ave SE
Charleston, WV 25304-1227

Mailing address

3200 Maccorkle Ave SE
Charleston, WV 25304-1227
Phone (304) 388-5432

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240829001600 WV Practitioner - Certified Registered Nurse Anesthetist (Crna) 9638618028 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

501 Morris St
Charleston, WV 25301-1326
Phone (304) 388-5432

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
100222WVMDRegistered Nurse
116456WVMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Charleston Area Medical Center, Inc. CurrentSince May 16, 2024 Accepting new patients
Charleston Area Medical Center Inc CurrentSince May 16, 2024 Accepting new patients

Locations

3200 Maccorkle Ave SE
Charleston, WV 25304
Phone (304) 388-2550

501 Morris St
Charleston, WV 25301
Phone (304) 348-6293

400 Association Dr
Ste 102
Charleston, WV 25311
Phone (304) 388-1762

Organizations & group practices 2

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 11

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": "1655164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699401600000",
    "number": "1134859036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3200 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041227",
            "telephone_number": "304-388-5432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3200 MACCORKLE AVE SE",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253041227",
            "telephone_number": "304-388-5432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUNYON",
        "first_name": "CASSIDY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-14",
        "last_updated": "2023-11-08",
        "certification_date": "2023-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WV",
            "license": "116456",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WV",
            "license": "100222",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2023; 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.