Individual provider Active NPI

James Decker, CRNA

  • Certified Registered Nurse Anesthetist
  • Hickory, NC
National Provider Identifier
1497857205
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
36670 Issued in NC
Practice address
810 Fairgrove Church Rd
Hickory, NC 28602-9617
Phone
(828) 326-3809
Fax
(828) 326-3371
NPI assigned
Sep 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 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 36670 NC Primary

Addresses

Primary practice location

810 Fairgrove Church Rd
Hickory, NC 28602-9617

Mailing address

1408 34TH Avenue LN NE
Hickory, NC 28601-7218
Phone (828) 326-3809

Other identifiers 1

IdentifierTypeStateIssuer
8051397MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100805000838 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 5890828297 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
36670NCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Catawba Valley Medical Center CurrentSince Jul 2, 2010 Accepting new patients
Catawba Valley Medical Center Current Accepting new patients
Catawba Valley Medical Center CurrentSince Jul 2, 2010 Accepting new patients

Locations

810 Fairgrove Church Rd
Hickory, NC 28602
Phone (704) 326-3000

Organizations & group practices 3

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": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1497857205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1408 34TH AVENUE LN NE",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286017218",
            "telephone_number": "828-326-3809",
            "fax_number": "828-326-3371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 FAIRGROVE CHURCH RD",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286029617",
            "telephone_number": "828-326-3809",
            "fax_number": "828-326-3371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECKER",
        "first_name": "JAMES",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-02",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "36670",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8051397",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hickory, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.