Individual provider Active NPI

Soo Min Summer Dewenter

  • Certified Registered Nurse Anesthetist
  • Falls Church, VA
National Provider Identifier
1437740982
Registry record updated Jan 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
0024180857 Issued in VA
Practice address
3300 Gallows Rd
Falls Church, VA 22042-3307
Phone
(703) 776-4001
NPI assigned
Jan 28, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 0001274958 VA
Certified Registered Nurse Anesthetist 367500000X 0024180857 VA Primary

Addresses

Primary practice location

3300 Gallows Rd
Falls Church, VA 22042-3307

Mailing address

2807 S Woodrow St Apt B
Arlington, VA 22206-3321
Phone (571) 275-0704

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, DC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210319000319 VA Practitioner - Certified Registered Nurse Anesthetist (Crna) 7618384686 Reassigns benefits to 2 organizations
I20210323001039 DC Practitioner - Certified Registered Nurse Anesthetist (Crna) 7618384686 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northstar Anesthesia of Virginia, LLCGroup PAC ID 6608268826, 407 clinicians

Practice addresses (Care Compare)

2501 Parkers LN
Alexandria, VA 22306-3209
Phone (703) 664-7000

3300 Gallows Rd
Falls Church, VA 22042-3307
Phone (703) 776-4001

Hospital & facility affiliations

  • Inova Fairfax Hospital Hospital, Falls Church, VA, CCN 490063

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0024180857VAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of Virginia, PC CurrentSince Feb 1, 2021 Accepting new patients
American Anesthesiology of Virginia PC CurrentSince Feb 1, 2021 Accepting new patients
Northstar Anesthesia of Virginia, LLC CurrentSince Jun 7, 2023 Accepting new patients

Locations

2501 Parkers Ln
Alexandria, VA 22306
Phone (703) 664-7000

736 Battlefield Blvd N
Chesapeake, VA 23320
Phone (757) 312-6124

541 Sunset Ln
Ste 201
Culpeper, VA 22701
Phone (540) 829-0700

3300 Gallows Rd
Falls Church, VA 22042
Phone (703) 352-9395

19455 Deerfield Ave
Ste 204
Leesburg, VA 20176
Phone (703) 724-9950

Organizations & group practices 3

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.

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": "1611792000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611792000000",
    "number": "1437740982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2807 S WOODROW ST APT B",
            "city": "ARLINGTON",
            "state": "VA",
            "postal_code": "222063321",
            "telephone_number": "571-275-0704"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 GALLOWS RD",
            "city": "FALLS CHURCH",
            "state": "VA",
            "postal_code": "220423307",
            "telephone_number": "703-776-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWENTER",
        "first_name": "SOO MIN",
        "middle_name": "SUMMER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-28",
        "last_updated": "2021-01-28",
        "certification_date": "2021-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "VA",
            "license": "0001274958",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0024180857",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Falls Church, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 28, 2021; 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.