Individual provider Active NPI

Debera W Moennich, CRNA

  • Certified Registered Nurse Anesthetist
  • Elyria, OH
National Provider Identifier
1164535159
Registry record updated Jan 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
122349 Issued in OH
Practice address
860 E Broad St
Suite I
Elyria, OH 44035-6542
Phone
(440) 323-8515
Fax
(440) 323-7900
NPI assigned
Aug 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 9, 2008

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 122349 OH Primary

Addresses

Primary practice location

860 E Broad St
Suite I
Elyria, OH 44035-6542

Mailing address

139 Westchester Dr
Amherst, OH 44001-3428
Phone (440) 988-8918

Other identifiers 1

IdentifierTypeStateIssuer
2144709MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
122349OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Bedford Anesthesiologists and Pain Management Past Accepting new patients
Associated Anesthesiologists of Toledo, Inc Past Accepting new patients
Elyria Anesthesia Incorporated PastSince May 17, 1993 Accepting new patients
Anesthesiology Consultants of Toledo, Inc Past Accepting new patients
Crna of Blanchard Valley LLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Ohio Surgical Anesthesia LLC Past Accepting new patients
Anesthesia Associates of Lima Inc Nurse Anesthetist, Certified Registered Past Accepting new patients

Organizations & group practices 8

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": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1199836800000",
    "number": "1164535159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "139 WESTCHESTER DR",
            "city": "AMHERST",
            "state": "OH",
            "postal_code": "440013428",
            "telephone_number": "440-988-8918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 E BROAD ST",
            "address_2": "SUITE I",
            "city": "ELYRIA",
            "state": "OH",
            "postal_code": "440356542",
            "telephone_number": "440-323-8515",
            "fax_number": "440-323-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOENNICH",
        "first_name": "DEBERA",
        "middle_name": "W",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-16",
        "last_updated": "2008-01-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "122349",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2144709",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Elyria, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.