Individual provider Active NPI

Justin Daw

  • Certified Registered Nurse Anesthetist
  • Loma Linda, CA
National Provider Identifier
1386184125
Registry record updated Feb 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
IN PROGRESS Issued in CA
Practice address
11159 Florence LN
Loma Linda, CA 92354-6562
Phone
(702) 353-1660
NPI assigned
Feb 27, 2017
Last updated
Feb 27, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2017

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X IN PROGRESS CA Primary
Registered Nurse 163W00000X 95051725 CA
Registered Nurse 163W00000X RN67937 NV

Addresses

Primary practice location

11159 Florence LN
Loma Linda, CA 92354-6562

Mailing address

11159 Florence LN
Loma Linda, CA 92354-6562

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170523000948 ID Practitioner - Certified Registered Nurse Anesthetist (Crna) 5395012389 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Associates of Boise, P.a.Group PAC ID 2668385287, 183 clinicians

Practice addresses (Care Compare)

1000 State St
McCall, ID 83638-3704
Phone (208) 634-2221

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
IN PROGRESSCAMDPsychologist
95051725CAMDRegistered Nurse
RN67937NVMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Associates of Boise, P.a. CurrentSince Apr 8, 2017 Accepting new patients

Locations

2537 W State St
Ste 200
Boise, ID 83702
Phone (208) 336-0895

338 E Bannock St
Boise, ID 83712
Phone (208) 336-0895

1000 State St
McCall, ID 83638
Phone (208) 634-2221

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1488153600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1488153600000",
    "number": "1386184125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11159 FLORENCE LN",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923546562"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11159 FLORENCE LN",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923546562",
            "telephone_number": "702-353-1660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAW",
        "first_name": "JUSTIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-02-27",
        "last_updated": "2017-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CA",
            "license": "IN PROGRESS",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95051725",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NV",
            "license": "RN67937",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Loma Linda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2017; 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.