Individual provider Active NPI

Paul J Butler, CRNA

  • Certified Registered Nurse Anesthetist
  • Albuquerque, NM
National Provider Identifier
1164536801
Registry record updated Jan 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
CRNA-01369 Issued in NM
Practice address
4520 Montgomery Blvd NE Ste 6
Albuquerque, NM 87109-1291
Phone
(505) 308-3145
Fax
(505) 308-3147
NPI assigned
Aug 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 26NR1159100 NJ
Certified Registered Nurse Anesthetist 367500000X 622779 TX
Certified Registered Nurse Anesthetist 367500000X CRNA-01369 NM Primary

Addresses

Primary practice location

4520 Montgomery Blvd NE Ste 6
Albuquerque, NM 87109-1291

Mailing address

4520 Montgomery Blvd NE Ste 6
Albuquerque, NM 87109-1291
Phone (505) 308-3145

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, AZ2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20151125000165 NM Practitioner - Certified Registered Nurse Anesthetist (Crna) 1759482946 Reassigns benefits to 2 organizations
I20240213004336 AZ Practitioner - Certified Registered Nurse Anesthetist (Crna) 1759482946 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Street Anesthesia of New Mexico, LLCGroup PAC ID 3476807538, 228 clinicians

Practice addresses (Care Compare)

117 E 19TH St
Lovelace Regional Hospital Roswell
Roswell, NM 88201-5151
Phone (575) 627-7000

211 Sudderth Dr
Ruidoso, NM 88345-6002
Phone (505) 257-7381

Hospital & facility affiliations

  • Presbyterian Hospital Hospital, Albuquerque, NM, CCN 320021
  • Lincoln County Medical Center Hospital, Ruidoso, NM, CCN 321306

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
622779TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Associates of New Mexico P C CurrentSince Jun 1, 2020 Accepting new patients
Northeastern Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Jan 30, 2024 Accepting new patients
Main Street Anesthesia of New Mexico, LLC CurrentSince Jan 1, 2019 Accepting new patients
Virtua Medical Group, PA Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

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

1100 Central Ave SE
Albuquerque, NM 87106
Phone (505) 724-6124

8300 Constitution Ave NE
Albuquerque, NM 87110
Phone (505) 291-2000

117 E 19th St
Roswell, NM 88201
Phone (505) 727-2000

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706572800000",
    "number": "1164536801",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4520 MONTGOMERY BLVD NE STE 6",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091291",
            "telephone_number": "505-308-3145",
            "fax_number": "505-308-3147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4520 MONTGOMERY BLVD NE STE 6",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871091291",
            "telephone_number": "505-308-3145",
            "fax_number": "505-308-3147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUTLER",
        "first_name": "PAUL",
        "middle_name": "J",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2024-01-30",
        "certification_date": "2024-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NJ",
            "license": "26NR1159100",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "622779",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NM",
            "license": "CRNA-01369",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 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.