NPIMap

Organization Active NPI

Woodland Park Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Woodland Park, CO
National Provider Identifier
1417249996
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
WOODLAND PARK ANESTHESIA LLC
Practice address
16420 W US Highway 24
Woodland Park, CO 80863-8760
Phone
(719) 687-9989
NPI assigned
May 3, 2011
Last updated
Dec 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Authorized official

Name
Lonnie W ClarkNPI 1598777450
Title
President
Phone
(806) 790-3928

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X CO Primary

Addresses

Primary practice location

16420 W US Highway 24
Woodland Park, CO 80863-8760

Mailing address

PO Box 9040
Woodland Park, CO 80866-9040
Phone (719) 900-3960

Other identifiers 2

IdentifierTypeStateIssuer
COAAA0139OtherCOMEDICARE PTAN
09932275MedicaidCO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110719000292 CO Part B Supplier - Clinic/Group Practice 3971771999 Receives reassigned benefits from 3 practitioners
Practice locations: Woodland Park, CO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1304380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607558400000",
    "number": "1417249996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9040",
            "city": "WOODLAND PARK",
            "state": "CO",
            "postal_code": "808669040",
            "telephone_number": "719-900-3960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16420 W US HIGHWAY 24",
            "city": "WOODLAND PARK",
            "state": "CO",
            "postal_code": "808638760",
            "telephone_number": "719-687-9989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODLAND PARK ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-03",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "LONNIE",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "806-790-3928"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "COAAA0139",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09932275",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodland Park, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; 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.