Walter P Theriot, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

C00615 Issued in AR

Practice address

1801 W 40TH Ave
Ste 2B
Pine Bluff, AR 71603-6957

Phone

(870) 535-7457

Fax

(870) 535-2522

NPI assigned

Jun 16, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jefferson Regional Anesthesia LLCGroup PAC ID 6204171846, 18 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Jefferson Regional Medical Center Hospital, Pine Bluff, AR, CCN 040071

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• Jefferson Regional Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Pine Bluff, AR
  • NPI 1205301587

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Premier Anesthesia of Arkansas Professional Corporation

  • Anesthesiology Physician
  • Fayetteville, AR
  • NPI 1932519485

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Jefferson Hospital Association Inc

  dba Jefferson Regional Medical Center

  • General Acute Care Hospital
  • Pine Bluff, AR
  • NPI 1710931985
  Care Compare affiliation

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

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214265600000",
    "number": "1356346316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1272",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716131272",
            "telephone_number": "870-535-7457",
            "fax_number": "870-535-2522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W 40TH AVE",
            "address_2": "STE 2B",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036957",
            "telephone_number": "870-535-7457",
            "fax_number": "870-535-2522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THERIOT",
        "first_name": "WALTER",
        "middle_name": "P",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2008-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "C00615",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RRMCR/PGBA",
            "identifier": "050072344",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "59655",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "127519701",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• The Pine Bluff Group, PLLC (Liberty Chiropractic)
• The Shavers-Cobb Foundation
• The Villages of General Baptist Health Care Assisted Living
• The Villages of General Baptist Health Care East
• The Villages of General Baptist Health Care West
• Denise Darlene Thomas
• Faytrene Thomas, MSE., CCC-SP
• Ivan Thomas
• Jestin Thomas
• Toni Thomas, LPN

• Certified Registered Nurse Anesthetist in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Certified Registered Nurse Anesthetist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2008; 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.