Individual provider Active NPI

Rebecca Wall, CRNA

  • Certified Registered Nurse Anesthetist
  • Lexington, KY
National Provider Identifier
1356300362
Registry record updated May 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3003248 Issued in KY
Practice address
425 Lewis Hargett Cir
Lexington, KY 40503-3590
Phone
(859) 268-1030
Fax
(859) 269-4120
NPI assigned
Mar 20, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2015

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 3003248 KY Primary

Addresses

Primary practice location

425 Lewis Hargett Cir
Lexington, KY 40503-3590

Mailing address

425 Lewis Hargett Cir
Lexington, KY 40503-3590
Phone (859) 268-1030

Other identifiers 1

IdentifierTypeStateIssuer
74002247MedicaidKY

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031218000017 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 4385541267 Reassigns benefits to 1 organization

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Anesthesia, PSC Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2022 Accepting new patients
Central Kentucky Anesthesia PSC Past Accepting new patients
Danville Anesthesia Associates, LLP Nurse Anesthetist, Certified Registered PastSince Apr 6, 2021 Accepting new patients

Locations

425 Lewis Hargett Cir
Lexington, KY 40503
Phone (606) 679-9322

310 S Limestone
Lexington, KY 40508
Phone (606) 252-6612

1725 Harrodsburg Rd
Lexington, KY 40504
Phone (606) 276-2525

4005 DuPont Cir
Louisville, KY 40207
Phone (502) 897-7401

2511 Terra Crossing Blvd
Louisville, KY 40245
Phone (502) 589-9488

175 Hospital Dr
Winchester, KY 40391
Phone (859) 745-3500

Organizations & group practices 3

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": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1432944000000",
    "number": "1356300362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 LEWIS HARGETT CIR",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405033590",
            "telephone_number": "859-268-1030",
            "fax_number": "859-269-4120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 LEWIS HARGETT CIR",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405033590",
            "telephone_number": "859-268-1030",
            "fax_number": "859-269-4120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALL",
        "first_name": "REBECCA",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-20",
        "last_updated": "2015-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3003248",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74002247",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lexington, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2015; 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.