Individual provider Active NPI

Arkeylla T Harris, CRNA

  • Certified Registered Nurse Anesthetist
  • Warren, OH
National Provider Identifier
1508188384
Registry record updated Jun 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
83424 Issued in OH
Practice address
667 Eastland Ave SE
Warren, OH 44484-4503
Phone
(330) 841-4000
Fax
(330) 841-4455
NPI assigned
Feb 22, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2023

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 RN.309209 OH
Certified Registered Nurse Anesthetist 367500000X 83424 OH Primary

Addresses

Primary practice location

667 Eastland Ave SE
Warren, OH 44484-4503

Mailing address

4135 Boardman Canfield Rd Ste 101
Canfield, OH 44406-9803
Phone (330) 286-5330

Other identifiers 3

IdentifierTypeStateIssuer
H140200OtherOHMEDICARE PTAN
12103722OtherCAQH
3039401MedicaidOH

Other names 1

  • Arkeylla T Thomas Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100511000172 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 9133257280 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Bel-Park Anesthesia Associates, Inc.Group PAC ID 8628974904, 158 clinicians

Practice addresses (Care Compare)

667 Eastland Seave
Warren, OH 44484-4503
Phone (330) 841-4000

Hospital & facility affiliations

  • MH St Joseph Warren Hospital Hospital, Warren, OH, CCN 360161

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN.309209OHMDRegistered Nurse
83424OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Bel-Park Anesthesia Associates, Inc. Nurse Anesthetist, Certified Registered CurrentSince Nov 1, 2012 Accepting new patients

Locations

4135 Boardman Canfield Rd
Ste 101
Canfield, OH 44406
Phone (330) 532-7215

667 Eastland Ave SE
Warren, OH 44484
Phone (330) 841-2378

3893 E Market St
Warren, OH 44484
Phone (330) 856-4000

1934 Niles Cortland Rd NE
Warren, OH 44484
Phone (330) 609-5170

1044 Belmont Ave
Youngstown, OH 44504
Phone (330) 480-2182

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 2

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": "1266796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686009600000",
    "number": "1508188384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4135 BOARDMAN CANFIELD RD STE 101",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444069803",
            "telephone_number": "330-286-5330",
            "fax_number": "330-286-5396"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "667 EASTLAND AVE SE",
            "city": "WARREN",
            "state": "OH",
            "postal_code": "444844503",
            "telephone_number": "330-841-4000",
            "fax_number": "330-841-4455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "ARKEYLLA",
        "middle_name": "T",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-22",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.309209",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "83424",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "H140200",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12103722",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3039401",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ARKEYLLA",
            "last_name": "THOMAS",
            "middle_name": "T",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Warren, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; 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.