Phillip Conwell Jr., CRNA
Individual provider Active NPI Registered Nurse · Fort Bragg, CA
NPI 1255540340 · NPPES record last updated Mar 18, 2024
Key facts
- NPI
- 1255540340
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Registered Nurse 163W00000X
- License
- RN405621 (CA)
- Practice address
- 700 River Dr
Fort Bragg, CA 95437-5403 - Phone
- (707) 961-1234
- NPI assigned
- May 22, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
-
John A Kermen, D.O.
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Progressive Anesthesia Consultants of California
Practice addresses (Care Compare)
5176 Hill Rd E
Lakeport, CA 95453-6300
Phone (707) 262-5000
700 River Dr
Fort Bragg, CA 95437-5403
Phone (707) 961-1234
Hospital & facility affiliations
- Adventist Health Mendocino Coast
Merit-based Incentive Payment System (MIPS)
- Final score
- 80.98 of 100
- Quality
- 73.31
- Promoting interoperability
- 92
- Improvement activities
- 40
- Cost
- 62
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050519000177 | CA | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 4789625898 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN405621 | CA | MD | Registered Nurse |
| 1064 | CA | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Adventist Health Mendocino Coast | Current |
Accepting new patients | |
| Adventist Health Mendocino Coast | Current |
Accepting new patients |
Locations
700 River Dr
Fort Bragg, CA 95437
Phone (707) 961-1234
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/29a5ccea-f4ab-4447-a191-56b20695970f/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN405621 | CA | Yes |
| Certified Registered Nurse Anesthetist | 367500000X | 1064 | CA |
Addresses
Primary practice location
700 River Dr
Fort Bragg, CA 95437-5403
Mailing address
PO Box 937
Mendocino, CA 95460-0937
Phone (707) 813-7639
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1064 | Other | CA | CALIFORNIA BOARD OF REGISTERED NURSING |
Other providers in Fort Bragg, CA
- Coast Healthcare Supply
- Coastal Functional Medicine
- Code 3 Mind Health, Inc.
- Abraham P Cohen
- Tabetha Connell
- John Ernest Cottle Jr.
- County of Mendocino
- County of Mendocino
- Courtney Morgan Cravens
- Sean Crawford
All providers in Fort Bragg, CA · Registered Nurse in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 18, 2024. 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.