Individual provider Active NPI

Nicholas Stoddard, CRNA

  • Certified Registered Nurse Anesthetist
  • Pocatello, ID
National Provider Identifier
1225330954
Registry record updated Feb 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RNA-821A Issued in ID
Practice address
777 Hospital Way
Pocatello, ID 83201-5175
Phone
(208) 232-7760
Fax
(208) 232-1950
NPI assigned
Dec 1, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2012

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 RNA-821A ID Primary

Addresses

Primary practice location

777 Hospital Way
Pocatello, ID 83201-5175

Mailing address

PO Box 4107
Pocatello, ID 83205-4107
Phone (208) 232-7760

Other identifiers 1

IdentifierTypeStateIssuer
RNA-821AOtherIDCRNA LICENCE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120803000056 ID Practitioner - Certified Registered Nurse Anesthetist (Crna) 9335395532 Reassigns benefits to 1 organization

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
Northstar Anesthesia of Idaho PLLCGroup PAC ID 6204283856, 37 clinicians

Practice addresses (Care Compare)

777 Hospital Way
Pocatello, ID 83201-5175
Phone (208) 239-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RNA-821AIDMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of Idaho PLLC CurrentSince Oct 1, 2023 Accepting new patients

Locations

777 Hospital Way
Pocatello, ID 83201
Phone (208) 239-1000

333 N 18th Ave
Ste C
Pocatello, ID 83201
Phone (208) 234-7800

1151 Hospital Way
Bldg A
Pocatello, ID 83201
Phone (208) 232-6616

Organizations & group practices 1

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 2

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": "1291161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329091200000",
    "number": "1225330954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4107",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832054107",
            "telephone_number": "208-232-7760",
            "fax_number": "208-232-1950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015175",
            "telephone_number": "208-232-7760",
            "fax_number": "208-232-1950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STODDARD",
        "first_name": "NICHOLAS",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-12-01",
        "last_updated": "2012-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ID",
            "license": "RNA-821A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRNA LICENCE",
            "identifier": "RNA-821A",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pocatello, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2012; 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.