NPIMap

Organization Active NPI

Genesis Anesthesia, PLLC

  • Certified Registered Nurse Anesthetist
  • Kaufman, TX
National Provider Identifier
1174974133
Registry record updated Jun 30, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
GENESIS ANESTHESIA, PLLC
Practice address
850 Ed Hall Dr
Kaufman, TX 75142-1861
Phone
(972) 932-7344
NPI assigned
Jun 30, 2016
Last updated
Jun 30, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2016

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

Authorized official

Name
Theodoor Christiaan Hancke, CRNANPI 1760710149
Title
Group President
Phone
(817) 529-2650

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X Primary

Addresses

Primary practice location

850 Ed Hall Dr
Kaufman, TX 75142-1861

Mailing address

4100 International PLZ
Suite 600
Fort Worth, TX 76109-4820
Phone (817) 529-2650

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160927000788 TX Part B Supplier - Clinic/Group Practice 1557658135 Receives reassigned benefits from 20 practitioners
Practice locations: Forney, TX; Kaufman, TX; Sulphur Springs, TX; Wichita Falls, TX

National Provider Directory

National Provider Directory

Locations

4100 International Plz
Ste 600
Ft Worth, TX 76109
Phone (817) 468-4000

2400 N Stallings Dr
Ste 405
Nacogdoches, TX 75964

Practitioners & affiliated clinicians

Practitioners 20

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 20

NPI Registry JSON

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

{
    "created_epoch": "1467244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467244800000",
    "number": "1174974133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4100 INTERNATIONAL PLZ",
            "address_2": "SUITE 600",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094820",
            "telephone_number": "817-529-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "850 ED HALL DR",
            "city": "KAUFMAN",
            "state": "TX",
            "postal_code": "751421861",
            "telephone_number": "972-932-7344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS ANESTHESIA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-30",
        "last_updated": "2016-06-30",
        "status": "A",
        "authorized_official_last_name": "HANCKE",
        "authorized_official_first_name": "THEODOOR",
        "authorized_official_middle_name": "CHRISTIAAN",
        "authorized_official_title_or_position": "GROUP PRESIDENT",
        "authorized_official_telephone_number": "817-529-2650",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kaufman, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2016; 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.