Individual provider Active NPI

William N Clark, CRNA

  • Certified Registered Nurse Anesthetist
  • Nellis AFB, NV
National Provider Identifier
1205157146
Registry record updated Jun 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
9500056 Issued in CA
Practice address
4700 Las Vegas Blvd N
Nellis AFB, NV 89191-6600
Phone
(702) 653-3550
NPI assigned
Jun 15, 2010
Last updated
Jun 10, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2020

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 9500056 CA Primary

Addresses

Primary practice location

4700 Las Vegas Blvd N
Nellis AFB, NV 89191-6600

Mailing address

4700 Las Vegas Blvd N
Nellis AFB, NV 89191-6600
Phone (702) 653-3550

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221021001792 CO Practitioner - Certified Registered Nurse Anesthetist (Crna) 2365670098 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Colorado Anesthesia Professionals PLLCGroup PAC ID 6800878760, 155 clinicians

Practice addresses (Care Compare)

200 Exempla Cir
Ncap PLLC
Lafayette, CO 80026-3370
Phone (303) 689-4000

2500 Rocky Mountain Ave
Loveland, CO 80538-9004

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9500056CAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Northern Colorado Anesthesia Professionals PLLC CurrentSince Jan 1, 2023 Accepting new patients
US Anesthesia Partners of Colorado Inc. Nurse Anesthetist, Certified Registered CurrentSince Aug 17, 2023 Accepting new patients

Locations

4567 E 9th Ave
Denver, CO 80220
Phone (303) 302-2121

3702 Automation Way
Ste 103
Fort Collins, CO 80525
Phone (970) 495-6201

8000 E Maplewood Ave
Ste 120
Greenwood Village, CO 80111

10101 Ridgegate Pkwy
Lone Tree, CO 80124
Phone (720) 225-1000

2500 Rocky Mountain Ave
Loveland, CO 80538
Phone (970) 297-6425

Organizations & group practices 2

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.

Hospital & facility affiliations 4

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": "1276560000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591747200000",
    "number": "1205157146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4700 LAS VEGAS BLVD N",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891916600",
            "telephone_number": "702-653-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "WILLIAM",
        "middle_name": "N",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-15",
        "last_updated": "2020-06-10",
        "certification_date": "2020-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CA",
            "license": "9500056",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nellis AFB, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2020; 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.