NPIMap

Individual provider Active NPI

Jackie K Lauer, CRNA

  • Certified Registered Nurse Anesthetist
  • Bloomfield, IA
National Provider Identifier
1184734634
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
D095191 Issued in IA
Practice address
505 W Jefferson St
Bloomfield, IA 52537-1515
Phone
(641) 664-3602
Fax
(641) 664-3765
NPI assigned
Aug 30, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 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 D095191 IA Primary

Addresses

Primary practice location

505 W Jefferson St
Bloomfield, IA 52537-1515

Mailing address

PO Box 54
Bloomfield, IA 52537-0054
Phone (641) 664-3602

Other identifiers 2

IdentifierTypeStateIssuer
0266437MedicaidIA
18740OtherIABCBS

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

State licenses

LicenseStateTypeSpecialty
D095191IAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Knoxville Area Anesthesia Services Nurse Anesthetist, Certified Registered Past Accepting new patients
Vaughan Regional Medical Center LLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Poplar Bluff Regional Medical Center Past Accepting new patients
Northland Anesthesiology Inc Past Accepting new patients
Central Kansas Anesthesia PA Nurse Anesthetist, Certified Registered Past Accepting new patients
Kirksville Anesthesia Associates, P.C. Nurse Anesthetist, Certified Registered Past Accepting new patients
Poplar Bluff Regional Medical Center LLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Vaughan Regional Medical Center LLC Past Accepting new patients
Bloomfield Anesthetists Nurse Anesthetist, Certified Registered Past Accepting new patients

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184734634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 54",
            "city": "BLOOMFIELD",
            "state": "IA",
            "postal_code": "525370054",
            "telephone_number": "641-664-3602",
            "fax_number": "641-664-3765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 W JEFFERSON ST",
            "city": "BLOOMFIELD",
            "state": "IA",
            "postal_code": "525371515",
            "telephone_number": "641-664-3602",
            "fax_number": "641-664-3765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAUER",
        "first_name": "JACKIE",
        "middle_name": "K",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IA",
            "license": "D095191",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0266437",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "18740",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomfield, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.