NPIMap

Individual provider Active NPI

Robert Converse, CAA

  • Anesthesiologist Assistant
  • Charleston, SC
National Provider Identifier
1457896375
Registry record updated May 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
75 Issued in SC
Practice address
2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733
Phone
(843) 402-1436
Fax
(843) 402-1833
NPI assigned
Jan 2, 2017
Last updated
May 10, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X ANT.0000072 CO
Anesthesiologist Assistant 367H00000X 75 SC Primary

Addresses

Primary practice location

2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733

Mailing address

PO Box 603484
Charlotte, NC 28260-3484
Phone (803) 765-1838

Other practice location 1

12605 E 16th Ave
Aurora, CO 80045-2545
Phone (720) 848-0000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, SC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170223002208 CO Practitioner - Anesthesiology Assistant 4486938164 Reassigns benefits to 1 organization
I20211102002941 SC Practitioner - Anesthesiology Assistant 4486938164 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
University of Colorado School of Medicine, Aurora, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Physicians IncorporatedGroup PAC ID 3476465667, 3,189 clinicians

Practice addresses (Care Compare)

12605 E 16TH Ave
Uchealth Anschutz Medical Campus
Aurora, CO 80045-2545
Phone (720) 848-0000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
75SCMDGerontology Nurse Practitioner
ANT.0000072COMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Bon Secours St. Francis Xavier Hosptial, Inc. CurrentSince Apr 28, 2021 Accepting new patients
Bon Secours St Francis Xavier Hospital, Inc. Current Accepting new patients
Bon Secours St. Francis Xavier Hospital, Inc. CurrentSince Feb 23, 2025 Accepting new patients
Atlantic Coast Anesthesia Services P.C. CurrentSince Aug 21, 2023 Accepting new patients
University Physicians Incorporated CurrentSince Sep 1, 2025 Accepting new patients
Bon Secours St. Francis Xavier Hospital, Inc. CurrentSince Apr 28, 2021 Accepting new patients

Locations

12605 E 16th Ave
Aurora, CO 80045
Phone (720) 848-0006

13123 E 16th Ave
Aurora, CO 80045
Phone (720) 777-3846

2095 Henry Tecklenburg Dr
Charleston, SC 29414
Phone (843) 402-1037

1021 Cipriana Dr
Ste 100
Myrtle Beach, SC 29572
Phone (843) 449-7885

809 82nd Pkwy
Myrtle Beach, SC 29572
Phone (843) 291-7182

Organizations & group practices 7

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 27

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1483315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715299200000",
    "number": "1457896375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603484",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603484",
            "telephone_number": "803-765-1838",
            "fax_number": "803-765-1732"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2095 HENRY TECKLENBURG DR",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294145733",
            "telephone_number": "843-402-1436",
            "fax_number": "843-402-1833"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12605 E 16th Ave",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "CO",
            "postal_code": "800452545",
            "country_code": "US",
            "telephone_number": "720-848-0000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONVERSE",
        "first_name": "ROBERT",
        "credential": "CAA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-01-02",
        "last_updated": "2024-05-10",
        "certification_date": "2024-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "CO",
            "license": "ANT.0000072",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "SC",
            "license": "75",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2024; 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.