Individual provider Active NPI

Lee Bendickson, CRNA

  • Certified Registered Nurse Anesthetist
  • Longview, WA
National Provider Identifier
1336486786
Registry record updated Feb 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
AP60333564 Issued in WA
Practice address
1615 Delaware St
Longview, WA 98632-2367
Phone
(360) 414-2000
Fax
(360) 414-7638
NPI assigned
Jan 4, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2020

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 00169917 WA
Certified Registered Nurse Anesthetist 367500000X AP60333564 WA Primary

Addresses

Primary practice location

1615 Delaware St
Longview, WA 98632-2367

Mailing address

9040 Jackson Ave
Tacoma, WA 98431-0001
Phone (253) 968-3885

Other practice location 1

900 Washington Rd
West Point, NY 10996-1109
Phone (845) 938-5169

Other practice location 2

9040 Jackson Ave
Tacoma, WA 98431
Phone (253) 968-3885

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200325002175 WA Practitioner - Certified Registered Nurse Anesthetist (Crna) 6507144250 Reassigns benefits to 1 organization

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
PeacehealthGroup PAC ID 5890689293, 188 clinicians

Practice addresses (Care Compare)

1615 Delaware St
Longview, WA 98632-2367
Phone (360) 636-4814

1660 Delware St
Longview, WA 98632-2310
Phone (360) 414-2800

Hospital & facility affiliations

  • Peacehealth St John Medical Center Hospital, Longview, WA, CCN 500041

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
00169917WAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Peacehealth CurrentSince Apr 27, 2020 Accepting new patients

Locations

1615 Delaware St
Longview, WA 98632
Phone (360) 363-4818

1115 SE 164th Ave
Dept 358
Vancouver, WA 98683
Phone (360) 729-1253

Interoperability endpoints

  • Direct secure messaging: lbendickson433810@direct.peacehealth.org

Organizations & group practices 5

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": "1357257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582156800000",
    "number": "1336486786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9040 JACKSON AVE",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984310001",
            "telephone_number": "253-968-3885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 DELAWARE ST",
            "city": "LONGVIEW",
            "state": "WA",
            "postal_code": "986322367",
            "telephone_number": "360-414-2000",
            "fax_number": "360-414-7638"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "900 Washington Rd",
            "address_purpose": "LOCATION",
            "city": "West Point",
            "state": "NY",
            "postal_code": "109961109",
            "country_code": "US",
            "telephone_number": "845-938-5169",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9040 Jackson Ave",
            "address_purpose": "LOCATION",
            "city": "Tacoma",
            "state": "WA",
            "postal_code": "98431",
            "country_code": "US",
            "telephone_number": "253-968-3885",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BENDICKSON",
        "first_name": "LEE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-01-04",
        "last_updated": "2020-02-20",
        "certification_date": "2020-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WA",
            "license": "00169917",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WA",
            "license": "AP60333564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Longview, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2020; 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.