Individual provider Active NPI

Philip Paul Adamczak

  • Certified Registered Nurse Anesthetist
  • Houston, TX
National Provider Identifier
1255489704
Registry record updated Aug 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
043809 Issued in TX
Practice address
2411 Fountain View Dr
Suite 200
Houston, TX 77057-4817
Phone
(713) 458-4185
NPI assigned
Jan 8, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2008

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 043809 TX Primary

Addresses

Primary practice location

2411 Fountain View Dr
Suite 200
Houston, TX 77057-4817

Mailing address

2411 Fountain View Dr Ste 200
Houston, TX 77057-4832
Phone (713) 620-4000

Other identifiers 3

IdentifierTypeStateIssuer
430029332OtherTXRAILROAD MEDICARE
003351601MedicaidTX
88588COtherTX-BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070613000514 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 7810095981 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
043809TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Utmb Faculty Group Practice CurrentSince Feb 1, 2008 Accepting new patients
Sound Physicians Anesthesiology of Texas PLLC CurrentSince Oct 16, 2020 Accepting new patients
Northstar Anesthesia, PA Nurse Anesthetist, Certified Registered CurrentSince Nov 5, 2013 Accepting new patients

Locations

2000 E Lamar Blvd
Ste 400
Arlington, TX 76006
Phone (817) 861-3994

909 9th Ave
Ft Worth, TX 76104
Phone (817) 336-6060

2001 W Rosedale St
Ft Worth, TX 76104
Phone (817) 877-4777

301 University Blvd
Galveston, TX 77555
Phone (409) 747-1883

1401 St Joseph Pkwy
Houston, TX 77002
Phone (713) 575-1000

1917 Ashland St
Houston, TX 77008
Phone (713) 861-6161

6560 Fannin St
Ste 600
Houston, TX 77030
Phone (713) 796-0500

6200 W Parker Rd
Plano, TX 75093
Phone (972) 608-8000

Organizations & group practices 3

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": "1168214400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218153600000",
    "number": "1255489704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2411 FOUNTAIN VIEW DR STE 200",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770574832",
            "telephone_number": "713-620-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2411 FOUNTAIN VIEW DR",
            "address_2": "SUITE 200",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770574817",
            "telephone_number": "713-458-4185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADAMCZAK",
        "first_name": "PHILIP",
        "middle_name": "PAUL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-08",
        "last_updated": "2008-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "043809",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "430029332",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003351601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TX-BLUE SHIELD",
            "identifier": "88588C",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2008; 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.