Individual provider Active NPI

Enrique Hernandez

  • Certified Registered Nurse Anesthetist
  • Phoenix, AZ
National Provider Identifier
1306481064
Registry record updated Sep 17, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
252210 Issued in AZ
Practice address
4605 E Elwood St Ste 500
Phoenix, AZ 85040-1978
Phone
(602) 200-9021
NPI assigned
Nov 16, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Certified Registered Nurse Anesthetist 367500000X 252210 AZ Primary

Addresses

Primary practice location

4605 E Elwood St Ste 500
Phoenix, AZ 85040-1978

Mailing address

2221 Lakeside Blvd Ste 600
Richardson, TX 75082-4416
Phone (972) 761-5509

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210118000482 AZ Practitioner - Certified Registered Nurse Anesthetist (Crna) 6103239900 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1400 S Dobson Rd
Mesa, AZ 85202-4707
Phone (480) 412-3000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.53 of 100Reported as group
Quality
78.73
Promoting interoperability
98
Improvement activities
40
Cost
62.46

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
252210AZMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Aug 1, 2025 Accepting new patients
Banner - University Hospital Based Physicians LLC CurrentSince May 15, 2023 Accepting new patients
Banner Hospital Based Physicians Arizona LLC Current Accepting new patients
Quality Medical Management Corp Nurse Anesthetist, Certified Registered CurrentSince Jun 24, 2025 Accepting new patients
Banner - University Hospital Based Physicians LLC CurrentSince May 15, 2023 Accepting new patients
Banner Hospital Based Physicians Arizona LLC CurrentSince Aug 1, 2025 Accepting new patients
Anesthesia Partners of Arizona LLC CurrentSince Jan 11, 2021 Accepting new patients

Locations

2394 N Alma School Rd
Ste 1
Chandler, AZ 85224
Phone (480) 963-0700

1400 S Dobson Rd
Mesa, AZ 85202
Phone (480) 412-3000

1111 E McDowell Rd
Phoenix, AZ 85006
Phone (602) 239-2000

4605 E Elwood St
Ste 500
Phoenix, AZ 85040
Phone (469) 998-7443

2221 Lakeside Blvd
Ste 600
Richardson, TX 75082
Phone (469) 998-7450

Organizations & group practices 8

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 1

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": "1573862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631836800000",
    "number": "1306481064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2221 LAKESIDE BLVD STE 600",
            "city": "RICHARDSON",
            "state": "TX",
            "postal_code": "750824416",
            "telephone_number": "972-761-5509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4605 E ELWOOD ST STE 500",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850401978",
            "telephone_number": "602-200-9021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNANDEZ",
        "first_name": "ENRIQUE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-16",
        "last_updated": "2021-09-17",
        "certification_date": "2021-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AZ",
            "license": "252210",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.