Individual provider Active NPI

Brian A Fedorchak, CRNA

  • Certified Registered Nurse Anesthetist
  • Roanoke, VA
National Provider Identifier
1306977194
Registry record updated Jan 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
0024168517 Issued in VA
Practice address
1906 Belleview Ave SE
Roanoke, VA 24014
Phone
(540) 853-0222
Fax
(540) 981-7855
NPI assigned
Mar 7, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2019

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 0024168517 VA Primary

Addresses

Primary practice location

1906 Belleview Ave SE
Roanoke, VA 24014

Mailing address

1906 Belleview Ave SE
Roanoke, VA 24014-1838
Phone (540) 853-0222

Other practice location 1

25500 Point Lookout Rd
Leonardtown, MD 20650-2015
Phone (301) 475-6204

Other identifiers 1

IdentifierTypeStateIssuer
R123817OtherMDLICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170901001878 VA Practitioner - Certified Registered Nurse Anesthetist (Crna) 1052506078 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carilion Professional Services LLCGroup PAC ID 2163323999, 86 clinicians

Practice addresses (Care Compare)

1906 Belleview Ave SE
Roanoke, VA 24014-1838
Phone (540) 853-0222

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0024168517VAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Professional Services LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 21, 2017 Accepting new patients

Locations

1906 Belleview Ave SE
Roanoke, VA 24014
Phone (540) 853-0222

180 Floyd Ave
Rocky Mount, VA 24151
Phone (540) 483-5277

Organizations & group practices 1

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": "1173225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1548720000000",
    "number": "1306977194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1906 BELLEVIEW AVE SE",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240141838",
            "telephone_number": "540-853-0222",
            "fax_number": "540-981-7855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 BELLEVIEW AVE SE",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "24014",
            "telephone_number": "540-853-0222",
            "fax_number": "540-981-7855"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "25500 Point Lookout Rd",
            "address_purpose": "LOCATION",
            "city": "Leonardtown",
            "state": "MD",
            "postal_code": "206502015",
            "country_code": "US",
            "telephone_number": "301-475-6204",
            "fax_number": "301-997-6507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FEDORCHAK",
        "first_name": "BRIAN",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-07",
        "last_updated": "2019-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0024168517",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "R123817",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; 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.