Organization Active NPI

Holly Tree Anesthesia

  • Certified Registered Nurse Anesthetist
  • Chico, CA
National Provider Identifier
1487372850
Registry record updated Jan 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
HOLLY TREE ANESTHESIA
Practice address
121 Raley Blvd
Chico, CA 95928-8347
Phone
(530) 370-6928
NPI assigned
Aug 22, 2022
Last updated
Jan 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2024

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

Authorized official

Name
Samuel A Acebo, CRNANPI 1083131445
Title
President
Phone
(530) 370-6928

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

121 Raley Blvd
Chico, CA 95928-8347

Mailing address

442 Dominica CT
Redding, CA 96003-2814
Phone (305) 243-0440

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220922001422 CA Part B Supplier - Clinic/Group Practice 9436534781 Receives reassigned benefits from 2 practitioners
Practice locations: Chico, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1661126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704326400000",
    "number": "1487372850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "442 DOMINICA CT",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960032814",
            "telephone_number": "305-243-0440",
            "fax_number": "530-243-0445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 RALEY BLVD",
            "city": "CHICO",
            "state": "CA",
            "postal_code": "959288347",
            "telephone_number": "530-370-6928"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HOLLY TREE ANESTHESIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-22",
        "last_updated": "2024-01-04",
        "certification_date": "2023-08-30",
        "status": "A",
        "authorized_official_last_name": "ACEBO",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "530-370-6928",
        "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": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chico, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.