Individual provider Active NPI

Vernon O Tucker, CRNA

  • Certified Registered Nurse Anesthetist
  • Rogers, AR
National Provider Identifier
1417937657
Registry record updated Feb 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
C000969 Issued in AR
Practice address
3728 S Pinnacle Hills Pkwy
Rogers, AR 72758-8897
Phone
(479) 790-3328
NPI assigned
Jan 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2023

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 C000969 AR Primary

Addresses

Primary practice location

3728 S Pinnacle Hills Pkwy
Rogers, AR 72758-8897

Mailing address

PO Box 583
Lowell, AR 72745-0583
Phone (888) 991-1101

Other identifiers 3

IdentifierTypeStateIssuer
917321903MedicaidMO
5T077OtherARBCBS
134260701MedicaidAR

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
C969ARMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Ouachita Regional Anesthesia PLLC Past Accepting new patients
Anesthesia Services of Benton County PA Past Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. PastSince Jul 1, 2022 Accepting new patients
Precision Surgical Center of Northwest Arkansas, LLC PastSince Oct 1, 2011 Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1137801600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675728000000",
    "number": "1417937657",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 583",
            "city": "LOWELL",
            "state": "AR",
            "postal_code": "727450583",
            "telephone_number": "888-991-1101",
            "fax_number": "903-787-5854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3728 S PINNACLE HILLS PKWY",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727588897",
            "telephone_number": "479-790-3328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "VERNON",
        "middle_name": "O",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-21",
        "last_updated": "2023-02-07",
        "certification_date": "2023-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "C000969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "917321903",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "5T077",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "134260701",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rogers, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2023; 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.