Individual provider Active NPI

Justin Waninger, CRNA

  • Certified Registered Nurse Anesthetist
  • Blacksburg, VA
National Provider Identifier
1497359012
Registry record updated Jan 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
0024180835 Issued in VA
Practice address
3700 S Main St
Blacksburg, VA 24060-7017
Phone
(540) 951-1111
NPI assigned
Nov 24, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 0001275299 VA
Certified Registered Nurse Anesthetist 367500000X 0024180835 VA Primary

Addresses

Primary practice location

3700 S Main St
Blacksburg, VA 24060-7017

Mailing address

1838 Carleton Dr
Salem, VA 24153
Phone (812) 630-0100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210312000299 VA Practitioner - Certified Registered Nurse Anesthetist (Crna) 0547676785 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Anesthesia PCGroup PAC ID 7416851597, 70 clinicians

Practice addresses (Care Compare)

3700 S Main St
Blacksburg, VA 24060-7017
Phone (540) 953-5374

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
0001275299VAMDGeneral Practice Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Valley Anesthesia PC CurrentSince Feb 1, 2021 Accepting new patients

Locations

3700 S Main St
Blacksburg, VA 24060
Phone (540) 951-1111

1900 Electric Rd
Salem, VA 24153
Phone (540) 772-3400

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1606176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611273600000",
    "number": "1497359012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1838 CARLETON DR",
            "city": "SALEM",
            "state": "VA",
            "postal_code": "24153",
            "telephone_number": "812-630-0100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3700 S MAIN ST",
            "city": "BLACKSBURG",
            "state": "VA",
            "postal_code": "240607017",
            "telephone_number": "540-951-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANINGER",
        "first_name": "JUSTIN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-24",
        "last_updated": "2021-01-22",
        "certification_date": "2021-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "VA",
            "license": "0001275299",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0024180835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Blacksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2021; 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.