Individual provider Active NPI

Therese F Oliver, CRNA

  • Certified Registered Nurse Anesthetist
  • Johnson City, NY
National Provider Identifier
1306141940
Registry record updated Nov 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4745811 Issued in NY
Practice address
156 Corliss Ave
Suite 107
Johnson City, NY 13790-2060
Phone
(607) 763-6735
Fax
(607) 763-6736
NPI assigned
Jan 12, 2011
Last updated
Nov 12, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 12, 2021

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 4745811 NY Primary

Addresses

Primary practice location

156 Corliss Ave
Suite 107
Johnson City, NY 13790-2060

Mailing address

40 Front St
Ste C
Binghamton, NY 13905-4712
Phone (607) 722-7264

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110322000575 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 9436332897 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Albany Medical College of Union University, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Riverside Associates in Anesthesia PCGroup PAC ID 5193792844, 26 clinicians
Agcny Physicians PLLCGroup PAC ID 4284804345, 36 clinicians
Chag Anesthesia PCGroup PAC ID 2668361973, 54 clinicians

Practice addresses (Care Compare)

169 Riveride Dr
Binghamton, NY 13905-4246
Phone (607) 722-7264

4309 Medical Ctr Dr
Fayetteville, NY 13066-6638
Phone (315) 329-7300

4900 Broad Rd
Syracuse, NY 13215-2265
Phone (315) 498-6200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4745811NYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Agcny Physicians PLLC CurrentSince Jan 1, 2026 Accepting new patients
Riverside Associates in Anesthesia PC CurrentSince Nov 15, 2021 Accepting new patients
Chag Anesthesia PC CurrentSince Nov 26, 2018 Accepting new patients
Upstate Medical Anesthesiology Group, Inc. CurrentSince Nov 26, 2018 Accepting new patients
United Health Services Hospitals, Inc. CurrentSince Apr 30, 2018 Accepting new patients

Locations

169 Riverside Dr
Binghamton, NY 13905
Phone (607) 798-5111

4309 Medical Center Dr
Fayetteville, NY 13066
Phone (315) 329-7300

4900 Broad Rd
Syracuse, NY 13215
Phone (315) 492-5011

5784 Widewaters Pkwy
Ste 2
Syracuse, NY 13214
Phone (315) 469-1134

750 E Adams St
Syracuse, NY 13210
Phone (315) 464-4363

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1294790400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636675200000",
    "number": "1306141940",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 FRONT ST",
            "address_2": "STE C",
            "city": "BINGHAMTON",
            "state": "NY",
            "postal_code": "139054712",
            "telephone_number": "607-722-7264",
            "fax_number": "607-722-7869"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "156 CORLISS AVE",
            "address_2": "SUITE 107",
            "city": "JOHNSON CITY",
            "state": "NY",
            "postal_code": "137902060",
            "telephone_number": "607-763-6735",
            "fax_number": "607-763-6736"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLIVER",
        "first_name": "THERESE",
        "middle_name": "F",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-12",
        "last_updated": "2021-11-12",
        "certification_date": "2021-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "4745811",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; 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.