Individual provider Active NPI

Durand Wagner, CRNA

  • Certified Registered Nurse Anesthetist
  • Dallas, TX
National Provider Identifier
1487753364
Registry record updated Aug 22, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN0000039771 Issued in TN
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, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
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

Enrollment IDStateProvider typePAC IDDetails
I20070209000115 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 7214987676 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
77.59 of 100Reported as group
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

LicenseStateTypeSpecialty
1203497TNMDRegistered Nurse
RN0000039771TNMDMedical-Surgical Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Tuba City Regional Health Care Corporation CurrentSince Sep 22, 2014 Accepting new patients
Tuba City Regional Health Care Corporation CurrentSince Sep 22, 2014 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.

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.

Verify at the official NPI Registry.