Individual provider Active NPI

Jason Lasource, CRNA

  • Certified Registered Nurse Anesthetist
  • Birmingham, AL
National Provider Identifier
1376092395
Registry record updated Oct 4, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1-129422 Issued in AL
Practice address
810 Saint Vincents Dr
Birmingham, AL 35205-1601
Phone
(205) 939-7143
NPI assigned
Oct 3, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2016

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 1-129422 AL Primary

Addresses

Primary practice location

810 Saint Vincents Dr
Birmingham, AL 35205-1601

Mailing address

PO Box 55310
Box 111
Birmingham, AL 35255-5310
Phone (205) 731-9701

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161011001688 AL Practitioner - Certified Registered Nurse Anesthetist (Crna) 3971891763 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eastern Shore Anesthesia, P.C.Group PAC ID 9830089978, 42 clinicians

Practice addresses (Care Compare)

750 Morphy Ave
Fairhope, AL 36532-1812
Phone (251) 990-1109

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Physynergy, LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2017 Accepting new patients
Physynergy, LLC Nurse Anesthetist, Certified Registered Current Accepting new patients
University of Alabama Health Services Foundation, PC. CurrentSince Oct 1, 2016 Accepting new patients
Eastern Shore Anesthesia PC CurrentSince Jul 1, 2019 Accepting new patients

Locations

810 Saint Vincents Dr
Birmingham, AL 35205
Phone (205) 930-2456

619 19th St S
Birmingham, AL 35233
Phone (205) 934-6405

619 19th St S
Birmingham, AL 35249

750 Morphy Ave
Fairhope, AL 36532
Phone (251) 928-2375

1 Hospital Dr SW
Huntsville, AL 35801
Phone (256) 429-4000

3719 Dauphin St
Mobile, AL 36608
Phone (251) 342-3000

Organizations & group practices 4

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": "1475452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1475539200000",
    "number": "1376092395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 55310",
            "address_2": "BOX 111",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352555310",
            "telephone_number": "205-731-9701",
            "fax_number": "205-297-9411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 SAINT VINCENTS DR",
            "city": "BIRMINGHAM",
            "state": "AL",
            "postal_code": "352051601",
            "telephone_number": "205-939-7143"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LASOURCE",
        "first_name": "JASON",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-10-03",
        "last_updated": "2016-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AL",
            "license": "1-129422",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Birmingham, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2016; 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.