NPIMap

Individual provider Active NPI

Charles Vincent Woodson, CRNA

  • Certified Registered Nurse Anesthetist
  • Bloomington, IN
National Provider Identifier
1497792659
Registry record updated Dec 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
28126400A Issued in IN
Practice address
2920 McIntire Drive, Suite 150
Attn: Maria Mitchell
Bloomington, IN 47403
Phone
(812) 337-5003
Fax
(812) 337-5010
NPI assigned
May 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 28126400A IN Primary

Addresses

Primary practice location

2920 McIntire Drive, Suite 150
Attn: Maria Mitchell
Bloomington, IN 47403

Mailing address

PO Box 5635
Attn: Maria Mitchell
Bloomington, IN 47407
Phone (812) 337-5003

Other identifiers 1

IdentifierTypeStateIssuer
000000386593OtherINSIA-ANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
28126400AINMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Amsol Anesthetists of Illinois, PC Nurse Anesthetist, Certified Registered Past Accepting new patients
Quincy Anesthesia Associates Past Accepting new patients
Wabash Valley Anesthesia Nurse Anesthetist, Certified Registered Past Accepting new patients
Southern Indiana Anesthesiology Nurse Anesthetist, Certified Registered Past Accepting new patients
Northern Indiana Anesthesia Services, P.C. Nurse Anesthetist, Certified Registered Past Accepting new patients
Granite City Clinic Corp Nurse Anesthetist, Certified Registered Past Accepting new patients
Amsol Anesthetists of Litchfield Il Nurse Anesthetist, Certified Registered Past Accepting new patients

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1197849600000",
    "number": "1497792659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5635",
            "address_2": "ATTN: MARIA MITCHELL",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47407",
            "telephone_number": "812-337-5003",
            "fax_number": "812-337-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2920 MCINTIRE DRIVE, SUITE 150",
            "address_2": "ATTN: MARIA MITCHELL",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "47403",
            "telephone_number": "812-337-5003",
            "fax_number": "812-337-5010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOODSON",
        "first_name": "CHARLES",
        "middle_name": "VINCENT",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2007-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "28126400A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SIA-ANTHEM",
            "identifier": "000000386593",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2007; 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.