Individual provider Active NPI

Todd Otte, CRNA

  • Certified Registered Nurse Anesthetist
  • Liberty, MO
National Provider Identifier
1417916040
Registry record updated Aug 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
104599 Issued in MO
Practice address
2525 Glenn Hendren Dr
Liberty, MO 64068-9625
Phone
(816) 781-7200
Fax
(816) 792-7196
NPI assigned
Mar 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 104599 MO Primary
Registered Nurse 163W00000X 104599 MO

Addresses

Primary practice location

2525 Glenn Hendren Dr
Liberty, MO 64068-9625

Mailing address

PO Box 804408
Kansas City, MO 64180-4408
Phone (816) 792-7126

Other identifiers 1

IdentifierTypeStateIssuer
912680303MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
104599MOMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Northland Anesthesiology Inc Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1377043200000",
    "number": "1417916040",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 804408",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641804408",
            "telephone_number": "816-792-7126",
            "fax_number": "816-792-7196"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 GLENN HENDREN DR",
            "city": "LIBERTY",
            "state": "MO",
            "postal_code": "640689625",
            "telephone_number": "816-781-7200",
            "fax_number": "816-792-7196"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OTTE",
        "first_name": "TODD",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-22",
        "last_updated": "2013-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "104599",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "104599",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "912680303",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Liberty, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.