John Wallace, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

CRNA 01415 Issued in NM

Practice address

4351 E Lohman Ave
Las Cruces, NM 88011-8259

Phone

(970) 216-5385

NPI assigned

Feb 18, 2016

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Enrolled in NM, CO, TX, MI4 enrollments

Enrollment records 4

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Novus Colorado Professional CorporationGroup PAC ID 0840694774, 12 clinicians

Spectrum Health Primary Care PartnersGroup PAC ID 4587568647, 2,283 clinicians

Las Cruces HB Medical Services LLCGroup PAC ID 8123473600, 157 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southwest Memorial Hospital Hospital, Cortez, CO, CCN 061327
• Mountain View Regional Medical Center Hospital, Las Cruces, NM, CCN 320085
• Spectrum Health Hospital, Grand Rapids, MI, CCN 230038

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• Las Cruces HB Medical Services LLC

  • Emergency Medicine Physician
  • Las Cruces, NM
  • NPI 1598446171
  Medicare reassignment Care Compare group NPD
• Novus Colorado Professional Corporation

  • Anesthesiology Physician
  • Cortez, CO
  • NPI 1437723640

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Spectrum Health Primary Care Partners

  • Internal Medicine Physician
  • Grand Rapids, MI
  • NPI 1235188673
  Medicare reassignment Care Compare group NPD
• Main Street Anesthesia of New Mexico, LLC

  • Anesthesiology Physician
  • Albuquerque, NM
  • NPI 1275010985
  Medicare reassignment NPD
• San Juan Regional Medical Center Inc

  • Gastroenterology Physician
  • Farmington, NM
  • NPI 1639662901
  Medicare reassignment NPD
• Animas Surgical Hospital, LLC

  • Emergency Medicine Physician
  • Durango, CO
  • NPI 1861721714

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Dallam-Hartley Counties Hospital District

  • Critical Access Hospital
  • Dalhart, TX
  • NPI 1245353747
  Medicare reassignment NPD
• Anesthesia Partners of Colorado

  • Anesthesiology Physician
  • Edwards, CO
  • NPI 1457702409
  Medicare reassignment
• San Juan Regional Medical Center Inc

  • Emergency Medicine Physician
  • Farmington, NM
  • NPI 1518932151
  NPD
• San Juan Regional Medical Center Inc

  • Family Medicine Physician
  • Farmington, NM
  • NPI 1710589015
  NPD
• Animas Surgical Hospital, LLC

  • Urgent Care Clinic/Center
  • Durango, CO
  • NPI 1194161422
  NPD
• Dallam-Hartley Counties Hospital District

  • Land Ambulance
  • Dalhart, TX
  • NPI 1689032856
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Las Cruces Medical Center LLC

  • General Acute Care Hospital
  • Las Cruces, NM
  • NPI 1205882503
  Care Compare affiliation
• Pennock Hospital

  • Critical Access Hospital
  • Hastings, MI
  • NPI 1932695525
  Care Compare affiliation
• Southwest Health System Inc

  • Critical Access Hospital
  • Cortez, CO
  • NPI 1649241571
  Care Compare affiliation
• Southwest Health System, Inc.

  • Land Ambulance
  • Cortez, CO
  • NPI 1679058184

  Hospital

  Care Compare affiliation
• Southwest Health System, Inc.

  • Non-emergency Medical Transport (VAN)
  • Cortez, CO
  • NPI 1992328074

  Hospital

  Care Compare affiliation
• Spectrum Health Hospitals

  • General Acute Care Hospital
  • Grand Rapids, MI
  • NPI 1922090554
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1455753600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1652227200000",
    "number": "1265891295",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 436",
            "city": "OURAY",
            "state": "CO",
            "postal_code": "814270436",
            "telephone_number": "970-216-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4351 E LOHMAN AVE",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880118259",
            "telephone_number": "970-216-5385"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2811 Tieton Dr",
            "address_purpose": "LOCATION",
            "city": "Yakima",
            "state": "WA",
            "postal_code": "989023761",
            "country_code": "US",
            "telephone_number": "970-216-5385",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "333 Smith Ave N",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551022344",
            "country_code": "US",
            "telephone_number": "651-241-4000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WALLACE",
        "first_name": "JOHN",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-02-18",
        "last_updated": "2022-05-11",
        "certification_date": "2022-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CO",
            "license": "APN.0996269-CRNA",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209021371",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "2355",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "10406-33",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WA",
            "license": "AP61248892",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NM",
            "license": "CRNA 01415",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Julie Ann Walker, LMSW
• Roger W. Walker
• Sarah Lynn Walker
• Shannon A Walker, MS
• Adam Leo Wallace
• Lura Wallace, LISW
• Michael Jon Wallace, CPSW
• Makayla Wallender
• Michelle Waller, RBT
• Wendi Cheree Wallin, DC

• Certified Registered Nurse Anesthetist in Las Cruces, NM
• Providers in Las Cruces, NM by specialty
• Certified Registered Nurse Anesthetist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2022; 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.