Individual provider Active NPI

Jamie Richardson, CRNA

  • Certified Registered Nurse Anesthetist
  • Kingwood, WV
National Provider Identifier
1255740411
Registry record updated Dec 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
76117 Issued in NM
Practice address
150 Memorial Dr
Kingwood, WV 26537-1141
Phone
(304) 329-1400
Fax
(304) 329-1175
NPI assigned
Aug 12, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2023

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 102842 FL
Certified Registered Nurse Anesthetist 367500000X APRN96208 WV
Certified Registered Nurse Anesthetist 367500000X 76117 NM Primary
Certified Registered Nurse Anesthetist 367500000X 96208 WV
Certified Registered Nurse Anesthetist 367500000X CRNA 1064 AZ

Addresses

Primary practice location

150 Memorial Dr
Kingwood, WV 26537-1141

Mailing address

150 Memorial Dr
Kingwood, WV 26537-1141
Phone (304) 329-1400

Other practice location 1

1850 N Central Ave Ste 1600
Phoenix, AZ 85004-4633
Phone (602) 262-8900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD, WV, NM, AR4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20160426000289 MD Practitioner - Certified Registered Nurse Anesthetist (Crna) 5890916399
I20180124001037 WV Practitioner - Certified Registered Nurse Anesthetist (Crna) 5890916399 Reassigns benefits to 2 organizations
I20240112001072 NM Practitioner - Certified Registered Nurse Anesthetist (Crna) 5890916399 Reassigns benefits to 1 organization
I20250204003798 AR Practitioner - Certified Registered Nurse Anesthetist (Crna) 5890916399 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Street Anesthesia of New Mexico, LLCGroup PAC ID 3476807538, 228 clinicians

Practice addresses (Care Compare)

2400 Unser Blvd SE
Suite 9100B
Rio Rancho, NM 87124-4740
Phone (720) 245-0321

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.04 of 100Reported as group
Quality
60.55
Promoting interoperability
100
Improvement activities
40
Cost
78.81

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CRNA 1064AZMDCertified Registered Nurse Anesthetist
102842FLMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Main Street Anesthesia of New Mexico, LLC CurrentSince Jan 1, 2024 Accepting new patients
Preston Memorial Hospital Corporation CurrentSince Nov 21, 2017 Accepting new patients
Renew Medical Group of Arkansas LTD Nurse Anesthetist, Certified Registered CurrentSince Feb 1, 2025 Accepting new patients
Preston Memorial Hospital Corporation CurrentSince Nov 21, 2017 Accepting new patients
Northstar Anesthesia of West Virginia, PLLC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2021 Accepting new patients

Locations

7301 Rogers Ave
Fort Smith, AR 72903
Phone (479) 314-4600

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

2400 Unser Blvd SE
Ste 9100B
Rio Rancho, NM 87124
Phone (505) 926-1400

117 E 19th St
Roswell, NM 88201
Phone (505) 727-2000

1340 Hal Greer Blvd
Huntington, WV 25701
Phone (304) 399-2960

150 Memorial Dr
Kingwood, WV 26537
Phone (304) 329-4701

1200 J D Anderson Dr
Morgantown, WV 26505
Phone (304) 598-1460

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/preston-adacdb24

Organizations & group practices 5

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 3

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": "1407801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1255740411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 MEMORIAL DR",
            "city": "KINGWOOD",
            "state": "WV",
            "postal_code": "265371141",
            "telephone_number": "304-329-1400",
            "fax_number": "304-329-1175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 MEMORIAL DR",
            "city": "KINGWOOD",
            "state": "WV",
            "postal_code": "265371141",
            "telephone_number": "304-329-1400",
            "fax_number": "304-329-1175"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1850 N Central Ave Ste 1600",
            "address_purpose": "LOCATION",
            "city": "Phoenix",
            "state": "AZ",
            "postal_code": "850044633",
            "country_code": "US",
            "telephone_number": "602-262-8900",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RICHARDSON",
        "first_name": "JAMIE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-08-12",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "102842",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WV",
            "license": "APRN96208",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NM",
            "license": "76117",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WV",
            "license": "96208",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AZ",
            "license": "CRNA 1064",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingwood, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; 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.