Individual provider Active NPI

Kristina Lynn O'Mara, CRNA

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
National Provider Identifier
1194021998
Registry record updated May 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
20484A Issued in SC
Practice address
1000 Blythe Blvd
Charlotte, NC 28203
Phone
(704) 355-2000
NPI assigned
Jan 27, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2018

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 20484A SC Primary

Addresses

Primary practice location

1000 Blythe Blvd
Charlotte, NC 28203

Mailing address

5025 Airport Center Pkwy BLDG L
Charlotte, NC 28208-5885
Phone (704) 512-7105

Other identifiers 2

IdentifierTypeStateIssuer
NAN994MedicaidSC
8053996MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110302000928 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 3274715875 Reassigns benefits to 5 organizations
I20180716001129 SC Practitioner - Certified Registered Nurse Anesthetist (Crna) 3274715875 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Associates of Rock Hill PAGroup PAC ID 6305740259, 58 clinicians
East Carolina Anesthesia Associates PLLCGroup PAC ID 5092720813, 691 clinicians

Practice addresses (Care Compare)

222 Herlong Ave S
Rock Hill, SC 29732-1158
Phone (803) 985-3089

2825 Randolph Rd
Charlotte, NC 28211-1018
Phone (704) 377-1647

Hospital & facility affiliations

  • Piedmont Medical Center Hospital, Rock Hill, SC, CCN 420002

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1886NCMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
CHS Anesthesia Services Group Inc CurrentSince Nov 15, 2017 Accepting new patients
Perioperative Services, LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 16, 2019 Accepting new patients
Gateway Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2025 Accepting new patients
East Carolina Anesthesia Associates, PLLC Nurse Anesthetist, Certified Registered CurrentSince Feb 15, 2022 Accepting new patients
Anesthesia Associates of Rock Hill, P.a. CurrentSince Jul 9, 2018 Accepting new patients
Providence Anesthesiology Associates, P.a. CurrentSince Apr 1, 2020 Accepting new patients
Mercy Hospital, Inc. Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

400 10th St E
Waconia, MN 55387

1822 Brunswick Ave
Charlotte, NC 28207
Phone (704) 342-4323

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

2825 Randolph Rd
Charlotte, NC 28211
Phone (704) 377-1647

2001 Vail Ave
Charlotte, NC 28207
Phone (704) 304-5000

3621 Randolph Rd
Charlotte, NC 28211
Phone (704) 206-8800

3735 Glenlake Dr
Ste 250
Charlotte, NC 28208
Phone (704) 749-5801

1918 Randolph Rd
Ste 740
Charlotte, NC 28207
Phone (704) 316-0810

1025 NE Gateway Ct NE
Concord, NC 28025
Phone (704) 920-7020

2430 Emerald Pl
Ste 103
Greenville, NC 27834
Phone (252) 752-2140

2536 Lengers Way
Indian Land, SC 29707
Phone (803) 313-3294

222 Herlong Ave S
Rock Hill, SC 29732
Phone (803) 324-1950

4100 International Plz
Ste 800
Ft Worth, TX 76109
Phone (855) 373-6862

Organizations & group practices 7

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": "1296086400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1526601600000",
    "number": "1194021998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5025 AIRPORT CENTER PKWY BLDG L",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282085885",
            "telephone_number": "704-512-7105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28203",
            "telephone_number": "704-355-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'MARA",
        "first_name": "KRISTINA",
        "middle_name": "LYNN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-27",
        "last_updated": "2018-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SC",
            "license": "20484A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NAN994",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8053996",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2018; 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.