Individual provider Active NPI

Elizabeth Blu Bamgbose, CRNA

  • Certified Registered Nurse Anesthetist
  • Los Angeles, CA
National Provider Identifier
1326133109
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
NA3613 Issued in CA
Practice address
1500 San Pablo St
Los Angeles, CA 90033-5313
Phone
(323) 442-7400
NPI assigned
Oct 4, 2006
Last updated
Nov 27, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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 NA3613 CA Primary

Addresses

Primary practice location

1500 San Pablo St
Los Angeles, CA 90033-5313

Mailing address

PO Box 31309
Los Angeles, CA 90031-0309
Phone (323) 442-7400

Other names 1

  • Elizabeth B. Glaser Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address elizabeth.glaser@direct.usc.edu Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100505000397 CA Practitioner - Certified Registered Nurse Anesthetist (Crna) 6709978760 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Axiom Anesthesia a Professional Nursing CorporationGroup PAC ID 5395133326, 3 clinicians

Practice addresses (Care Compare)

2811 Wilshire Blvd
Suite 690
Santa Monica, CA 90403-4816
Phone (310) 829-5968

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3613CAMDSchool Psychologist
NA3613CAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Usc Care Medical Group, Inc CurrentSince Feb 11, 2010 Accepting new patients
Axiom Anesthesia a Professional Nursing Corporation CurrentSince Aug 13, 2021 Accepting new patients
Usc Care Medical Group, Inc CurrentSince Feb 11, 2010 Accepting new patients
West Ridge Anesthesia PC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2020 Accepting new patients

Locations

240 S La Cienega Blvd
Ste 200
Beverly Hills, CA 90211
Phone (310) 882-5454

1500 San Pablo St
Los Angeles, CA 90033
Phone (323) 443-8500

1520 San Pablo St
Los Angeles, CA 90033
Phone (323) 442-5849

1520 San Pablo St
Fl 4
Los Angeles, CA 90033
Phone (323) 442-5849

2801 Wilshire Blvd
Ste B
Santa Monica, CA 90403
Phone (323) 289-2389

2811 Wilshire Blvd
Ste 690
Santa Monica, CA 90403
Phone (310) 828-7239

1050 Wall St W
Ste 360
Lyndhurst, NJ 07071
Phone (201) 821-7900

Interoperability endpoints

  • Direct secure messaging: elizabeth.glaser@direct.usc.edu

Organizations & group practices 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701043200000",
    "number": "1326133109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 31309",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900310309",
            "telephone_number": "323-442-7400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 SAN PABLO ST",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900335313",
            "telephone_number": "323-442-7400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAMGBOSE",
        "first_name": "ELIZABETH",
        "middle_name": "BLU",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2023-11-27",
        "certification_date": "2020-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CA",
            "license": "NA3613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "elizabeth.glaser@direct.usc.edu",
            "affiliation": "Y",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1500 San Pablo St",
            "city": "Los Angeles",
            "state": "CA",
            "country_code": "US",
            "postal_code": "900335313",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "GLASER",
            "middle_name": "B.",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2023; 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.