Individual provider Active NPI

Lisa D Vallely, CRNA

  • Certified Registered Nurse Anesthetist
  • Albany, GA
National Provider Identifier
1174514715
Registry record updated Sep 19, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN174251 Issued in GA
Practice address
2000 Palmyra Rd
Albany, GA 31701-1528
Phone
(229) 434-2161
Fax
(229) 434-2502
NPI assigned
Nov 2, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 19, 2007

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 RN174251 GA Primary

Addresses

Primary practice location

2000 Palmyra Rd
Albany, GA 31701-1528

Mailing address

2000 Palmyra Rd
Albany, GA 31701-1528
Phone (229) 434-2161

Other identifiers 1

IdentifierTypeStateIssuer
466225647AMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20091009000080 AL Practitioner - Certified Registered Nurse Anesthetist (Crna) 8820052665 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

619 19TH St S
Birmingham, AL 35249-1900
Phone (205) 934-4011

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN174251GAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Alabama Health Services Foundation, PC. CurrentSince Apr 1, 2015 Accepting new patients
RPB Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince Sep 6, 2024 Accepting new patients
Palmyra Professional Fees LLC Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

619 19th St S
Birmingham, AL 35249

1317 4th Ave S
Birmingham, AL 35233
Phone (205) 458-5000

810 Saint Vincents Dr
Birmingham, AL 35205
Phone (205) 930-2456

619 19th St S
Birmingham, AL 35233
Phone (205) 934-6405

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.

Hospital & facility affiliations 1

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": "1130889600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1190160000000",
    "number": "1174514715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 PALMYRA RD",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317011528",
            "telephone_number": "229-434-2161",
            "fax_number": "229-434-2502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 PALMYRA RD",
            "city": "ALBANY",
            "state": "GA",
            "postal_code": "317011528",
            "telephone_number": "229-434-2161",
            "fax_number": "229-434-2502"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VALLELY",
        "first_name": "LISA",
        "middle_name": "D",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-11-02",
        "last_updated": "2007-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN174251",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "466225647A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Albany, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2007; 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.