Individual provider Active NPI

Andrea Lea Etheridge, CRNA

  • Certified Registered Nurse Anesthetist
  • Bryan, TX
National Provider Identifier
1346585973
Registry record updated Dec 8, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
728571 Issued in TX
Practice address
1737 Briarcrest Dr
Suite 14
Bryan, TX 77802-2769
Phone
(214) 300-8179
NPI assigned
Dec 8, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2012

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 728571 TX Primary

Addresses

Primary practice location

1737 Briarcrest Dr
Suite 14
Bryan, TX 77802-2769

Mailing address

1737 Briarcrest Dr
Suite 14
Bryan, TX 77802-2769
Phone (214) 300-8179

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130506000342 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 2567609803 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
Austin Anesthesiology Group PLLCGroup PAC ID 0547256497, 430 clinicians

Practice addresses (Care Compare)

1604 Rock Prairie Rd
College Station, TX 77845-8345
Phone (979) 764-5100

Hospital & facility affiliations

  • CHI St Joseph Health Regional Hospital Hospital, Bryan, TX, CCN 450011

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
728571TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Austin Anesthesiology Group PLLC CurrentSince Feb 2, 2013 Accepting new patients
Austin Anesthesiology Group, PLLC Nurse Anesthetist, Certified Registered Current Accepting new patients

Locations

919 E 32nd St
Austin, TX 78705
Phone (512) 343-2466

1737 Briarcrest Dr
Ste 14
Bryan, TX 77802
Phone (409) 776-4777

2801 Franciscan Dr
Bryan, TX 77802
Phone (409) 776-3777

Interoperability endpoints

  • Direct secure messaging: aletheri@yourcarecommunity.org

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 2

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": "1354924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354924800000",
    "number": "1346585973",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1737 BRIARCREST DR",
            "address_2": "SUITE 14",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022769",
            "telephone_number": "214-300-8179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1737 BRIARCREST DR",
            "address_2": "SUITE 14",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778022769",
            "telephone_number": "214-300-8179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETHERIDGE",
        "first_name": "ANDREA",
        "middle_name": "LEA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-12-08",
        "last_updated": "2012-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "728571",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryan, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2012; 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.