Individual provider Active NPI

Melissa Green, CRNA

  • Certified Registered Nurse Anesthetist
  • Lakeside, AZ
National Provider Identifier
1144258989
Registry record updated Nov 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN156511 Issued in AZ
Practice address
5080 Mogollon Rim Dr
Lakeside, AZ 85929-5530
Phone
(480) 297-5926
NPI assigned
Jun 29, 2006
Last updated
Nov 2, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2011

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 RN156511 AZ Primary

Addresses

Primary practice location

5080 Mogollon Rim Dr
Lakeside, AZ 85929-5530

Mailing address

5080 Mogollon Rim Dr
Lakeside, AZ 85929-5530
Phone (480) 297-5926

Other names 1

  • Melissa Kemper Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090311000690 AZ Practitioner - Certified Registered Nurse Anesthetist (Crna) 9436100989 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN156511AZMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Northeastern Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2011 Accepting new patients
Northern Indiana Anesthesia Services, P.C. Nurse Anesthetist, Certified Registered Past Accepting new patients
Anesthesia Associates of Savannah ,PA Past Accepting new patients
Southern Girl Anesthesia Services Inc Nurse Anesthetist, Certified Registered PastSince Mar 16, 2009 Accepting new patients

Locations

2200 E Show Low Lake Rd
Show Low, AZ 85901
Phone (928) 537-4375

5700 E Highway 90
Sierra Vista, AZ 85635
Phone (520) 263-2000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1320192000000",
    "number": "1144258989",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5080 MOGOLLON RIM DR",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859295530",
            "telephone_number": "480-297-5926"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5080 MOGOLLON RIM DR",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859295530",
            "telephone_number": "480-297-5926"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "MELISSA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-29",
        "last_updated": "2011-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AZ",
            "license": "RN156511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "KEMPER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Lakeside, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; 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.