Ivan Gene Bledsoe, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

726382 Issued in TX

Practice address

6606 LBJ Fwy
Suite 200
Dallas, TX 75240

Phone

(972) 715-5000

Fax

(972) 715-9976

NPI assigned

Dec 2, 2005

Last updated

Jun 1, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

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.

• Presbyterian Hospital of Dallas

  dba Crna-PHD

  • Certified Registered Nurse Anesthetist
  • Dallas, TX
  • NPI 1750335618

  Nurse Anesthetist, Certified Registered

  NPD (past)
• Anesthesia Associates of Kansas City PA

  • Anesthesiology Physician
  • Overland Park, KS
  • NPI 1174504732
  NPD (past)

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527811200000",
    "number": "1457335408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840853",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752840853",
            "telephone_number": "972-233-1999",
            "fax_number": "972-233-3666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6606 LBJ FWY",
            "address_2": "SUITE 200",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "75240",
            "telephone_number": "972-715-5000",
            "fax_number": "972-715-9976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLEDSOE",
        "first_name": "IVAN",
        "middle_name": "GENE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-02",
        "last_updated": "2018-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KS",
            "license": "55042",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "726382",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "198389203",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "198389201",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8792UG",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILRAOD",
            "identifier": "P01445701",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "89574U",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "917483901",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100419530A",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "P00792988",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Blaze Iom Reading, PLLC
• Jennifer Marie Blazek, LPC
• Monica Ann Blazek, MD
• Christin Rentzel Blazevich, APRN
• Dana Allison Bleakney, M.D.
• Mallory Ladonna Bledsoe, CRNA
• Michelle Bledsoe, LPC
• Odile C Bledsoe
• Deborah Bleecker
• Blessed Hands Assistance Living Facility

• Certified Registered Nurse Anesthetist in Dallas, TX
• Providers in Dallas, TX by specialty
• Certified Registered Nurse Anesthetist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2018; 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.