Individual provider Active NPI

Amanda Donnelly, CRNA

  • Certified Registered Nurse Anesthetist
  • Kettering, OH
National Provider Identifier
1245535871
Registry record updated Sep 1, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
APRN.CRNA.12155 Issued in OH
Practice address
3535 Southern Blvd
Kettering, OH 45429-1221
Phone
(937) 293-8228
Fax
(937) 293-8229
NPI assigned
Jan 12, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN-279333 OH
Certified Registered Nurse Anesthetist 367500000X APRN.CRNA.12155 OH Primary

Addresses

Primary practice location

3535 Southern Blvd
Kettering, OH 45429-1221

Mailing address

PO Box 932759
Cleveland, OH 44193-0015
Phone (937) 293-8228

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110307000609 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 5092997411 Reassigns benefits to 6 organizations
I20231006001358 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 5092997411 Reassigns benefits to 1 organization

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
Arlington Anesthesia Partners LLCGroup PAC ID 7618344698, 91 clinicians
Ogi Anesthesia, LLCGroup PAC ID 8224290598, 35 clinicians

Practice addresses (Care Compare)

100 Medical Ctr Dr
Springfield, OH 45504-2687
Phone (614) 352-6479

2355 Derr Rd
Springfield, OH 45503-2439
Phone (513) 872-4541

600 N Pickaway St
Circleville, OH 43113-1447
Phone (614) 352-6479

Hospital & facility affiliations

  • Springfield Regional Medical Center Hospital, Springfield, OH, CCN 360086

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN.CRNA.12155OHMDCertified Registered Nurse Anesthetist
RN-279333OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of Missouri, LLC Nurse Anesthetist, Certified Registered CurrentSince Sep 3, 2023 Accepting new patients
Ogi Anesthesia, LLC Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2024 Accepting new patients
Northstar Anesthesia of Ohio LLC CurrentSince Sep 22, 2016 Accepting new patients
Dayton Anesthesia & Pain Services, LLC Nurse Anesthetist, Certified Registered CurrentSince Jun 25, 2015 Accepting new patients
Southwest Ohio Anesthesia Consultants LLC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2021 Accepting new patients
Arlington Anesthesia Partners LLC CurrentSince Jun 19, 2024 Accepting new patients
Anesthesia Associates of Cincinnati, Inc Nurse Anesthetist, Certified Registered CurrentSince Jan 3, 2018 Accepting new patients
Children'S Anesthesia Group Inc Nurse Anesthetist, Certified Registered Past Accepting new patients
Pediatric Anesthesia Associates of Dayton, Inc. Past Accepting new patients

Locations

13500 Powers Ct
Ste 230
Fort Myers, FL 33912
Phone (239) 610-0784

100 Mercy Way
Joplin, MO 64804
Phone (417) 556-2300

1000 Carondelet Dr
Kansas City, MO 64114
Phone (816) 942-4400

3535 Pentagon Blvd
Beavercreek, OH 45431
Phone (937) 702-4000

2139 Auburn Ave
Cincinnati, OH 45219
Phone (513) 585-0406

7500 State Rd
Cincinnati, OH 45255
Phone (513) 624-4034

2925 Vernon Pl
Ste 101
Cincinnati, OH 45219
Phone (513) 872-4541

600 N Pickaway St
Circleville, OH 43113
Phone (614) 352-6479

405 W Grand Ave
Dayton, OH 45405
Phone (937) 226-3200

1 Wyoming St
Dayton, OH 45409
Phone (937) 208-2636

630 Eaton Ave
Hamilton, OH 45013
Phone (513) 867-2000

2355 Derr Rd
Ste F
Springfield, OH 45503

2355 Derr Rd
Springfield, OH 45503
Phone (937) 398-1966

2610 N Limestone St
Springfield, OH 45503
Phone (614) 352-6479

2615 E High St
Springfield, OH 45505
Phone (888) 861-3994

195 Wadsworth Rd
Wadsworth, OH 44281
Phone (330) 331-1000

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 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": "1294790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598918400000",
    "number": "1245535871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 932759",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441930015",
            "telephone_number": "937-293-8228",
            "fax_number": "937-293-8229"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 SOUTHERN BLVD",
            "city": "KETTERING",
            "state": "OH",
            "postal_code": "454291221",
            "telephone_number": "937-293-8228",
            "fax_number": "937-293-8229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DONNELLY",
        "first_name": "AMANDA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-12",
        "last_updated": "2020-09-01",
        "certification_date": "2020-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "RN-279333",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "APRN.CRNA.12155",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kettering, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 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.