Active NPI
Durand Wagner, CRNA
- Certified Registered Nurse Anesthetist
- Dallas, TX
National Provider Identifier
1487753364
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- RN0000039771
- Practice address
- 13601 Preston Rd
Ste 1000W
Dallas, TX 75240-4911 - Phone
- (972) 715-5007
- Fax
- (972) 715-5682
- NPI assigned
- Sep 21, 2006
- Last updated
- Aug 22, 2011
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | RN0000039771 | TN | Primary |
| Registered Nurse | 163W00000X | 1203497 | TN | |
| Medical-Surgical Registered Nurse | 163WM0705X | RN0000039771 | TN |
Addresses
Primary practice location
13601 Preston Rd
Ste 1000W
Dallas, TX 75240-4911
Mailing address
PO Box 650426
Dallas, TX 75265-0426
Phone (972) 715-5000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
Care Compare profile
Medicare Care CompareMerit-based Incentive Payment System (MIPS)
- Final score
- 77.59 of 100
- Quality
- 47.51
- Promoting interoperability
- 69
- Improvement activities
- 40
- Cost
- 86.96
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1203497 | TN | MD | Registered Nurse |
| RN0000039771 | TN | MD | Medical-Surgical Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tuba City Regional Health Care Corporation | Current | Accepting new patients | |
| Tuba City Regional Health Care Corporation | Current | Accepting new patients | |
| Mid-America Anesthesia Consultants, PC | Past | Accepting new patients | |
| Delta Regional Anesthesiology Group | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
Organizations & group practices 4
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.
-
dba Tuba City Indian Medical Center
- General Acute Care Hospital
- Tuba City, AZ
- NPI 1548294424
TX
-
dba Bodaway Gap Clinic
- Family Medicine Physician
- Bodaway Gap, AZ
- NPI 1710519913
-
- Anesthesiology Physician
- Greenville, MS
- NPI 1720059249
Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Columbia, MO
- NPI 1083728463
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1313971200000",
"number": "1487753364",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 650426",
"city": "DALLAS",
"state": "TX",
"postal_code": "752650426",
"telephone_number": "972-715-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13601 PRESTON RD",
"address_2": "STE 1000W",
"city": "DALLAS",
"state": "TX",
"postal_code": "752404911",
"telephone_number": "972-715-5007",
"fax_number": "972-715-5682"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "DURAND",
"name_prefix": "Mr.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-21",
"last_updated": "2011-08-22",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "TN",
"license": "RN0000039771",
"primary": true
},
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "TN",
"license": "1203497",
"primary": false
},
{
"code": "163WM0705X",
"taxonomy_group": "",
"desc": "Registered Nurse, Medical-Surgical",
"state": "TN",
"license": "RN0000039771",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2011; 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.