Individual provider Active NPI

Shane R Syme, CRNA

  • Certified Registered Nurse Anesthetist
  • Henderson, NV
National Provider Identifier
1508014556
Registry record updated Feb 18, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
CRNA000344 Issued in NV
Practice address
129 W Lake Mead Pkwy
#B-18
Henderson, NV 89015-7055
Phone
(702) 564-4440
Fax
(702) 558-1522
NPI assigned
Sep 3, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2009

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 CRNA000344 NV Primary

Addresses

Primary practice location

129 W Lake Mead Pkwy
#B-18
Henderson, NV 89015-7055

Mailing address

129 W Lake Mead Pkwy
#B-18
Henderson, NV 89015-7055
Phone (702) 564-4440

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidNV

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100507000632 UT Practitioner - Certified Registered Nurse Anesthetist (Crna) 0648335505 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CRNA000344NVMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Skies Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 2, 2025 Accepting new patients
Red Rocks Surgical Center PC PastSince Oct 9, 2022 Accepting new patients
John T Goodsell DO PC Gregory Linderer MD LTD PastSince Nov 18, 2009 Accepting new patients

Locations

624 S 1000 E
Ste 105
St George, UT 84790
Phone (435) 274-7450

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, 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": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1234915200000",
    "number": "1508014556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "129 W LAKE MEAD PKWY",
            "address_2": "#B-18",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890157055",
            "telephone_number": "702-564-4440",
            "fax_number": "702-558-1522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "129 W LAKE MEAD PKWY",
            "address_2": "#B-18",
            "city": "HENDERSON",
            "state": "NV",
            "postal_code": "890157055",
            "telephone_number": "702-564-4440",
            "fax_number": "702-558-1522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SYME",
        "first_name": "SHANE",
        "middle_name": "R",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-03",
        "last_updated": "2009-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NV",
            "license": "CRNA000344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Henderson, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2009; 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.