Individual provider Active NPI

Brian N Herndon, CRNA

  • Certified Registered Nurse Anesthetist
  • Yakima, WA
National Provider Identifier
1417966839
Registry record updated Dec 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
AP30007249 Issued in WA
Practice address
406 S 30TH Ave
Ste 202
Yakima, WA 98902-3713
Phone
(509) 972-1051
Fax
(509) 972-4166
NPI assigned
Aug 5, 2006
Last updated
Dec 17, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2007

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 AP30007249 WA Primary

Addresses

Primary practice location

406 S 30TH Ave
Ste 202
Yakima, WA 98902-3713

Mailing address

406 S 30TH Ave
Ste 202
Yakima, WA 98902-3713
Phone (509) 972-1051

Other identifiers 2

IdentifierTypeStateIssuer
P00282250OtherWARAILROAD MEDICARE
9647645MedicaidWA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150113001032 ID Practitioner - Certified Registered Nurse Anesthetist (Crna) 3678589009 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
JC Edwards School of Medicine, Marshall University, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
River City Anesthesia Associates PLLCGroup PAC ID 4385534445, 22 clinicians

Practice addresses (Care Compare)

1593 E Polston Ave
Post Falls, ID 83854-5326
Phone (208) 262-2300

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AP30007249WAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
River City Anesthesia Associates, PLLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2015 Accepting new patients
Physician Anesthesia Assoc Inc PS PastSince Nov 21, 2016 Accepting new patients

Locations

1593 E Polston Ave
Post Falls, ID 83854
Phone (208) 262-2300

Organizations & group practices 2

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 4

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": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197849600000",
    "number": "1417966839",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "406 S 30TH AVE",
            "address_2": "STE 202",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023713",
            "telephone_number": "509-972-1051",
            "fax_number": "509-972-4166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "406 S 30TH AVE",
            "address_2": "STE 202",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023713",
            "telephone_number": "509-972-1051",
            "fax_number": "509-972-4166"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERNDON",
        "first_name": "BRIAN",
        "middle_name": "N",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-05",
        "last_updated": "2007-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WA",
            "license": "AP30007249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00282250",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9647645",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yakima, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; 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.