Brock Minor
Individual provider Active NPI Certified Registered Nurse Anesthetist · Bryan, OH
NPI 1245968320 · NPPES record last updated Oct 3, 2022
Key facts
- NPI
- 1245968320
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- APRN.CRNA.0020602 (OH)
- Practice address
- 433 W High St
Bryan, OH 43506-1690 - Phone
- (419) 636-1131
- Fax
- (419) 636-3100
- NPI assigned
- Aug 8, 2022
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2022
- Medicare assignment
- May accept Medicare assignment
- Group practices
- Clinical Colleagues Inc
Practice addresses (Care Compare)
433 W High St
Bryan, OH 43506-1690
Phone (419) 636-1311
Hospital & facility affiliations
- Community Hospitals and Wellness Centers
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220915003288 | OH | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 2365827045 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN.452752 | OH | MD | Critical Care Medicine Registered Nurse |
| APRN.CRNA.0020602 | OH | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Clinical Colleagues Inc | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
Locations
121 Westfield Dr
Archbold, OH 43502
Phone (419) 445-2015
433 W High St
Bryan, OH 43506
Phone (419) 636-1131
1250 S Washington St
Van Wert, OH 45891
Phone (419) 232-2077
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | APRN.CRNA.0020602 | OH | Yes |
| Critical Care Medicine Registered Nurse | 163WC0200X | RN.452752 | OH |
Addresses
Primary practice location
433 W High St
Bryan, OH 43506-1690
Mailing address
433 W High St
Bryan, OH 43506-1690
Phone (419) 636-1131
Other providers in Bryan, OH
- Midwest Community Health Associates, Inc.
- Becky Jo Miller
- Kimberly Jo Miller
- Mark Anthony Miller
- Kyle Mills
- Emily Monroe
- Brooke E Moore
- Sean Moran
- Kathleen Ann Moreau
- Katie Sue Moreland
All providers in Bryan, OH · Certified Registered Nurse Anesthetist in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 3, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.