Individual provider Active NPI

Evangelista M Mullinax, CRNA

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
National Provider Identifier
1336197219
Registry record updated Jul 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
68743 Issued in NC
Practice address
200 Hawthorne Lane
Charlotte, NC 28204
Phone
(704) 384-4239
Fax
(704) 384-5636
NPI assigned
May 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 6, 2017

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 68743 NC Primary

Addresses

Primary practice location

200 Hawthorne Lane
Charlotte, NC 28204

Mailing address

PO Box 601549
Charlotte, NC 28260-1549
Phone (704) 384-4239

Other identifiers 2

IdentifierTypeStateIssuer
NAN092MedicaidSC
8050829MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070912000689 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 4880787449 Reassigns benefits to 5 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
68743NCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
CHS Anesthesia Services Group Inc CurrentSince Nov 18, 2018 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Dec 1, 2013 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2013 Accepting new patients
CMC-Northeast, Inc. Nurse Anesthetist, Certified Registered CurrentSince Oct 17, 2011 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
Gateway Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince May 1, 2009 Accepting new patients
The Presbyterian Hospital CurrentSince Jan 1, 1989 Accepting new patients
Carolinas Medical Center-Northeast CurrentSince Oct 17, 2011 Accepting new patients
The Presbyterian Hospital Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 1989 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Past Accepting new patients
Gateway Ambulatory Surgery Center, LLC Past Accepting new patients

Locations

400 10th St E
Waconia, MN 55387

200 Hawthorne Ln
Fl 2
Charlotte, NC 28204
Phone (704) 384-4274

1800 E 4th St
Charlotte, NC 28204
Phone (704) 342-1824

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

920 Church St N
Concord, NC 28025
Phone (704) 403-3000

1025 NE Gateway Ct NE
Concord, NC 28025
Phone (704) 920-7020

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1146700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1499299200000",
    "number": "1336197219",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 601549",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282601549",
            "telephone_number": "704-384-4239",
            "fax_number": "704-384-5636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 HAWTHORNE LANE",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28204",
            "telephone_number": "704-384-4239",
            "fax_number": "704-384-5636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLINAX",
        "first_name": "EVANGELISTA",
        "middle_name": "M",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-04",
        "last_updated": "2017-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "68743",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NAN092",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8050829",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.