Individual provider Active NPI

Shan Allen Couvillion, CRNA

  • Certified Registered Nurse Anesthetist
  • Houston, TX
National Provider Identifier
1326353244
Registry record updated May 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
795280 Issued in TX
Practice address
2411 Fountain View Dr
Ste. 200
Houston, TX 77057-4817
Phone
(713) 620-4000
NPI assigned
Aug 16, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN100337 LA
Certified Registered Nurse Anesthetist 367500000X 795280 TX Primary

Addresses

Primary practice location

2411 Fountain View Dr
Ste. 200
Houston, TX 77057-4817

Mailing address

2411 Fountain View Dr
Ste. 200
Houston, TX 77057-4817
Phone (713) 620-4000

Other identifiers 1

IdentifierTypeStateIssuer
8479UBOtherTXBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100917000858 LA Practitioner - Certified Registered Nurse Anesthetist (Crna) 2163547837 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesiology Group Associates IncGroup PAC ID 0042110298, 155 clinicians

Practice addresses (Care Compare)

7777 Hennessy Blvd
Suite 301
Baton Rouge, LA 70808-0319
Phone (225) 214-6438

Hospital & facility affiliations

  • Our Lady of the Lake Regional Medical Center Hospital, Baton Rouge, LA, CCN 190064

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN100337LAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesiology Group Associates Inc CurrentSince Sep 1, 2018 Accepting new patients
Surgical Anesthesia of Baton Rouge LLC Past Accepting new patients

Locations

11414 Lake Sherwood Ave N
Baton Rouge, LA 70816
Phone (225) 532-4058

7777 Hennessy Blvd
Ste 301
Baton Rouge, LA 70808
Phone (225) 214-6436

Organizations & group practices 2

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": "1281916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304985600000",
    "number": "1326353244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2411 FOUNTAIN VIEW DR",
            "address_2": "STE. 200",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770574817",
            "telephone_number": "713-620-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2411 FOUNTAIN VIEW DR",
            "address_2": "STE. 200",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770574817",
            "telephone_number": "713-620-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COUVILLION",
        "first_name": "SHAN",
        "middle_name": "ALLEN",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-08-16",
        "last_updated": "2011-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "LA",
            "license": "RN100337",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "795280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "8479UB",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Houston, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2011; 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.