Active NPI
Renny Boase
- Certified Registered Nurse Anesthetist
- College Station, TX
National Provider Identifier
1457313561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 221600
- Practice address
- 1600 University Dr E
College Station, TX 77840-2642 - Phone
- (409) 691-3300
- NPI assigned
- Apr 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 221600 | TX | Primary |
Addresses
Primary practice location
1600 University Dr E
College Station, TX 77840-2642
Mailing address
PO Box 847556
Dallas, TX 75284-7556
Phone (254) 724-2111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 84451U | Other | TX | BLUE SHIELD |
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
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 221600 | TX | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184025600000",
"number": "1457313561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 847556",
"city": "DALLAS",
"state": "TX",
"postal_code": "752847556",
"telephone_number": "254-724-2111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 UNIVERSITY DR E",
"city": "COLLEGE STATION",
"state": "TX",
"postal_code": "778402642",
"telephone_number": "409-691-3300"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOASE",
"first_name": "RENNY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-04",
"last_updated": "2007-07-10",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "TX",
"license": "221600",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE SHIELD",
"identifier": "84451U",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in College Station, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.