Active NPI
Andrew Zoltan Selos, CRNA
- Certified Registered Nurse Anesthetist
- Raleigh, NC
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 91104
- Practice address
- 4420 Lake Boone TRL
Raleigh, NC 27607-7505 - Phone
- (919) 784-3100
- NPI assigned
- Jun 1, 2012
- Last updated
- Jul 21, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 183667 | NC | |
| Certified Registered Nurse Anesthetist | 367500000X | 91104 | NC | Primary |
Addresses
Primary practice location
4420 Lake Boone TRL
Raleigh, NC 27607-7505
Mailing address
3100 Spring Forest Rd Ste 130
Raleigh, NC 27616-2880
Phone (919) 882-0795
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
516 Vonderburg Dr
Brandon, FL 33511-5954
Phone (813) 654-7771
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 91104 | NC | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gulf-to-Bay Anesthesiology Associates LLC | Current | Accepting new patients | |
| Gulf-to-Bay Anesthesiology Associates LLC | Current | Accepting new patients |
Locations
24040 Tamiami Trl
Bonita Springs, FL 34134
Phone (239) 624-7153
516 Vonderburg Dr
Brandon, FL 33511
Phone (813) 654-7771
15238 Virginia Sta
Odessa, FL 33556
Phone (813) 596-5200
4016 Sun City Center Blvd
Sun City Ctr, FL 33573
Phone (813) 634-0145
1 Tampa General Cir
University of Tampa, FL 33606
Phone (813) 251-0793
265 Brookview Centre Way
Ste 400
Knoxville, TN 37919
Phone (865) 293-5549
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Anesthesiology Physician
- Tampa, FL
- NPI 1720039746
-
- Anesthesiology Physician
- Largo, FL
- NPI 1316205339
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1338508800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1336400761",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3100 SPRING FOREST RD STE 130",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276162880",
"telephone_number": "919-882-0795",
"fax_number": "919-873-9821"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4420 LAKE BOONE TRL",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276077505",
"telephone_number": "919-784-3100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SELOS",
"first_name": "ANDREW",
"middle_name": "ZOLTAN",
"name_prefix": "Mr.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-06-01",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NC",
"license": "183667",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "NC",
"license": "91104",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.