Individual provider Active NPI

James Douglas McDonald II, CRNA,MSN,BSN

  • Certified Registered Nurse Anesthetist
  • Fort Sam Houston, TX
National Provider Identifier
1174501480
Registry record updated Oct 21, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
730473 Issued in TX
Practice address
3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504
Phone
(210) 916-8709
NPI assigned
Jan 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 21, 2021

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 730473 TX Primary

Addresses

Primary practice location

3551 Roger Brooke Dr
Fort Sam Houston, TX 78234-4504

Mailing address

2267 Lakeview Dr
Canyon Lake, TX 78133-3448
Phone (210) 289-5019

Other names 1

  • Jim McDonald Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070320000273 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 8729181383 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endo Sedation LLCGroup PAC ID 4789845363, 289 clinicians

Practice addresses (Care Compare)

5223 Hamilton Wolfe Rd
San Antonio, TX 78229-4463
Phone (210) 614-1234

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Bachelor on Science - Nursing, Certified Registered Nurse, Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
730473TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Endo Sedation LLC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2021 Accepting new patients
Endo Sedation LLC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2021 Accepting new patients
Endo Sedation LLC Nurse Anesthetist, Certified Registered Current Accepting new patients

Locations

1001 Surrey Ln
Flower Mound, TX 75022
Phone (817) 337-3671

180 Bear Creek Pkwy
Keller, TX 76248
Phone (817) 337-3671

855 Proton Rd
San Antonio, TX 78258
Phone (210) 582-8000

5223 Hamilton Wolfe Rd
San Antonio, TX 78229
Phone 2106141234713

Organizations & group practices 3

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": "1136505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1634774400000",
    "number": "1174501480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2267 LAKEVIEW DR",
            "city": "CANYON LAKE",
            "state": "TX",
            "postal_code": "781333448",
            "telephone_number": "210-289-5019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3551 ROGER BROOKE DR",
            "city": "FORT SAM HOUSTON",
            "state": "TX",
            "postal_code": "782344504",
            "telephone_number": "210-916-8709"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDONALD",
        "first_name": "JAMES",
        "middle_name": "DOUGLAS",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "CRNA,MSN,BSN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-01-06",
        "last_updated": "2021-10-21",
        "certification_date": "2021-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "730473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JIM",
            "last_name": "MCDONALD",
            "credential": "CRNA, MSN, BSN",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fort Sam Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2021; 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.