Individual provider Active NPI

Daniel Christopher Mazzella, CRNA

  • Certified Registered Nurse Anesthetist
  • Charleston, WV
National Provider Identifier
1508154592
Registry record updated Dec 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
085360 Issued in WV
Practice address
333 Laidley St
Charleston, WV 25301-1614
Phone
(304) 347-6500
NPI assigned
Jul 12, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 48555 WV
Certified Registered Nurse Anesthetist 367500000X 085360 WV Primary

Addresses

Primary practice location

333 Laidley St
Charleston, WV 25301-1614

Mailing address

110 Roane St
Charleston, WV 25302-2334
Phone (304) 344-0096

Other identifiers 3

IdentifierTypeStateIssuer
3810021321MedicaidWV
Q37026AOtherWVMEDICARE PTAN
P00981780OtherWVMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110914000045 WV Practitioner - Certified Registered Nurse Anesthetist (Crna) 8123299658 Reassigns benefits to 1 organization
I20200601002059 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 8123299658 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Firsthealth of the Carolinas IncGroup PAC ID 8820909377, 138 clinicians

Practice addresses (Care Compare)

155 Memorial Dr
Pinehurst, NC 28374-8710
Phone (910) 215-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.75 of 100Reported as group
Quality
77.19
Promoting interoperability
86
Improvement activities
40
Cost
80.74

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
48555WVMDRegistered Nurse
085360WVMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Firsthealth of the Carolinas, Inc Nurse Anesthetist, Certified Registered CurrentSince Apr 22, 2020 Accepting new patients
Firsthealth of the Carolinas, Inc Dba Firsthealth Weight Management Clinic CurrentSince Apr 22, 2020 Accepting new patients
Professional Anesthesia Service,Inc. CurrentSince Aug 31, 2011 Accepting new patients

Locations

155 Memorial Dr
Pinehurst, NC 28374
Phone (910) 215-1000

520 Allen St
Troy, NC 27371
Phone (910) 571-5000

333 Laidley St
Charleston, WV 25301
Phone (304) 347-6116

110 Roane St
Charleston, WV 25302
Phone (304) 344-0096

4605 Maccorkle Ave SW
South Charleston, WV 25309
Phone (304) 414-4800

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.

Hospital & facility affiliations 4

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": "1310428800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325030400000",
    "number": "1508154592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ROANE ST",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253022334",
            "telephone_number": "304-344-0096",
            "fax_number": "304-342-4725"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "333 LAIDLEY ST",
            "city": "CHARLESTON",
            "state": "WV",
            "postal_code": "253011614",
            "telephone_number": "304-347-6500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZZELLA",
        "first_name": "DANIEL",
        "middle_name": "CHRISTOPHER",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-12",
        "last_updated": "2011-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WV",
            "license": "48555",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WV",
            "license": "085360",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810021321",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "Q37026A",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00981780",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.