Individual provider Active NPI

Marie Adele Burkstaller, CRNA

  • Certified Registered Nurse Anesthetist
  • Baton Rouge, LA
National Provider Identifier
1245211341
Registry record updated May 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN06722 Issued in LA
Practice address
9103 Jefferson Hwy
Baton Rouge, LA 70809-2440
Phone
(225) 927-1190
Fax
(225) 706-0160
NPI assigned
Nov 7, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 12, 2014

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 RN06722 LA Primary

Addresses

Primary practice location

9103 Jefferson Hwy
Baton Rouge, LA 70809-2440

Mailing address

9103 Jefferson Hwy
Baton Rouge, LA 70809-2440
Phone (225) 927-1190

Other identifiers 2

IdentifierTypeStateIssuer
1539775MedicaidLA
P00019003OtherLARR MEDICARE

Other names 1

  • Marie Adele Bergeron Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040325001213 LA Practitioner - Certified Registered Nurse Anesthetist (Crna) 1557253564 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
RN06722LAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesiology Affiliates, LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 12, 2009 Accepting new patients
Melanie C. Firmin, MD Apmc Past Accepting new patients
Louisiana Anesthesiology Group, L.L.C. Past Accepting new patients
Anesthesiology Group Associates Inc Past Accepting new patients
DRS Burleigh, Dupleix and Rees Past Accepting new patients
Surgical Anesthesia of Baton Rouge LLC Past Accepting new patients
Crescent City Anesthesia Services, LLC Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

9103 Jefferson Hwy
Baton Rouge, LA 70809
Phone (225) 927-1190

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.

NPI Registry JSON

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

{
    "created_epoch": "1131321600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1399852800000",
    "number": "1245211341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9103 JEFFERSON HWY",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708092440",
            "telephone_number": "225-927-1190",
            "fax_number": "225-706-0160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9103 JEFFERSON HWY",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708092440",
            "telephone_number": "225-927-1190",
            "fax_number": "225-706-0160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKSTALLER",
        "first_name": "MARIE",
        "middle_name": "ADELE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-07",
        "last_updated": "2014-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "LA",
            "license": "RN06722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1539775",
            "state": "LA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00019003",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARIE",
            "last_name": "BERGERON",
            "middle_name": "ADELE",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Baton Rouge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2014; 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.