NPIMap

Organization Active NPI

Sundance Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Spokane, WA
National Provider Identifier
1467167221
Registry record updated Jan 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
SUNDANCE ANESTHESIA LLC
Practice address
6002 S Yale Rd
Spokane, WA 99223-1744
Phone
(509) 990-5997
Fax
(509) 228-9542
NPI assigned
Jan 17, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 17, 2023

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

Authorized official

Name
Kerri Wagner, CRNANPI 1386870715
Title
Owner
Phone
(509) 926-1770

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

6002 S Yale Rd
Spokane, WA 99223-1744

Mailing address

6002 S Yale Rd
Spokane, WA 99223-1744
Phone (509) 990-5997

Other identifiers 1

IdentifierTypeStateIssuer
AP60097099OtherWAWASHINGTON STATE DEPARTMENT OF HEALTH

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://brickmed.com/

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1673913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1673913600000",
    "number": "1467167221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6002 S YALE RD",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992231744",
            "telephone_number": "509-990-5997",
            "fax_number": "509-228-9542"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6002 S YALE RD",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992231744",
            "telephone_number": "509-990-5997",
            "fax_number": "509-228-9542"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUNDANCE ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-17",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "KERRI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-926-1770",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WASHINGTON STATE DEPARTMENT OF HEALTH",
            "identifier": "AP60097099",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://brickmed.com/",
            "affiliation": "N",
            "endpointDescription": "BrickMed EMR/EHR",
            "address_1": "6002 S Yale Rd",
            "city": "Spokane",
            "state": "WA",
            "country_code": "US",
            "postal_code": "992231744",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Spokane, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; 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.