Active NPI
Larry Wayne Shock Jr., CRNA
- Certified Registered Nurse Anesthetist
- Dallas, TX
National Provider Identifier
1265717904
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 786298
- Practice address
- 13737 Noel Road
Suite 1400
Dallas, TX 75240-2004 - Phone
- (972) 715-5000
- Fax
- (972) 715-9976
- NPI assigned
- Oct 13, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 786298 | TX | |
| Certified Registered Nurse Anesthetist | 367500000X | 786298 | TX | Primary |
Addresses
Primary practice location
13737 Noel Road
Suite 1400
Dallas, TX 75240-2004
Mailing address
PO Box 650865
Dallas, TX 75265-0865
Phone (972) 715-5000
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P01102917 | Other | TX | RAILROAD MEDICARE PTAN |
| 200458930A | Medicaid | OK | |
| 8476UD | Other | TX | BCBS PIN |
| 306652401 | Medicaid | TX |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OK, HI
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2011
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
4401 S Western Ave
Oklahoma City, OK 73109-3413
Phone (405) 636-7000
4801 Integris Pkwy
Edmond, OK 73034-8864
Phone (405) 713-4565
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medstream Anesthesia Hawaii, LLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Anesthesia Medical Professionals, PLLC | Current | Accepting new patients |
Locations
67-1125 Mamalahoa Hwy
Kamuela, HI 96743
Phone (808) 881-4400
4801 Integris Pkwy
Edmond, OK 73034
Phone (405) 657-3000
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.
-
- Anesthesiology Physician
- Edmond, OK
- NPI 1962785931
-
- Anesthesiology Physician
- Kamuela, HI
- NPI 1346621190
Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Oklahoma City, OK
- NPI 1265376677
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Psychiatric Hospital Unit
- Oklahoma City, OK
- NPI 1598837221
-
- Psychiatric Hospital Unit
- Spencer, OK
- NPI 1659443372
-
- General Acute Care Hospital
- Oklahoma City, OK
- NPI 1831103654
-
- Psychiatric Hospital Unit
- Spencer, OK
- NPI 1881760759
-
- Mammography Clinic/Center
- Oklahoma City, OK
- NPI 1336155779
Hospital
-
- Rehabilitation Hospital Unit
- Oklahoma City, OK
- NPI 1336252717
-
- General Acute Care Hospital
- Oklahoma City, OK
- NPI 1457372625
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1318464000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400630400000",
"number": "1265717904",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 650865",
"city": "DALLAS",
"state": "TX",
"postal_code": "752650865",
"telephone_number": "972-715-5000",
"fax_number": "972-715-9976"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13737 NOEL ROAD",
"address_2": "SUITE 1400",
"city": "DALLAS",
"state": "TX",
"postal_code": "752402004",
"telephone_number": "972-715-5000",
"fax_number": "972-715-9976"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOCK",
"first_name": "LARRY",
"middle_name": "WAYNE",
"name_suffix": "Jr.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-10-13",
"last_updated": "2014-05-21",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "TX",
"license": "786298",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "TX",
"license": "786298",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE PTAN",
"identifier": "P01102917",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200458930A",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PIN",
"identifier": "8476UD",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "306652401",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2014; 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.