Individual provider Active NPI

Sandra Gembus, C.R.N.A.

  • Certified Registered Nurse Anesthetist
  • Cleveland, OH
National Provider Identifier
1578643003
Registry record updated Dec 19, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
041899 Issued in OH
Practice address
10515 Carnegie Ave
Cleveland, OH 44106-3016
Phone
(216) 928-0136
Fax
(216) 928-0141
NPI assigned
Oct 17, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 19, 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 RN211887 OH
Certified Registered Nurse Anesthetist 367500000X 041899 OH Primary

Addresses

Primary practice location

10515 Carnegie Ave
Cleveland, OH 44106-3016

Mailing address

10515 Carnegie Ave
Cleveland, OH 44106-3016
Phone (216) 928-0136

Other practice location 1

22715 Fairview Center Dr
Fairview Park, OH 44126-3608
Phone (440) 777-8400

Other identifiers 3

IdentifierTypeStateIssuer
000000127087OtherOHANTHEM
430036930OtherOHRAILROAD MEDICARE
0903919MedicaidOH

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090701000007 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 6305997461 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
78.79 of 100Reported as group
Quality
71.01
Improvement activities
40
Cost
82.45

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN211887OHMDRegistered Nurse
041899OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Radius Anesthesia of Ohio, LLC CurrentSince Oct 8, 2022 Accepting new patients
Ohio Anesthesia Group, Inc Nurse Anesthetist, Certified Registered CurrentSince Dec 15, 2023 Accepting new patients
Ohio Surgical Anesthesia LLC Past Accepting new patients

Locations

111 Town Square Pl
Ste 420
Jersey City, NJ 07310
Phone (201) 258-4700

1320 Timken Mercy Dr NW
Canton, OH 44708
Phone (330) 489-1000

175 S 3rd St
Ste 200
Columbus, OH 43215
Phone (267) 817-8902

22715 Fairview Center Dr
Fairview Park, OH 44126
Phone (330) 810-5797

29017 Cedar Rd
Lyndhurst, OH 44124
Phone (440) 255-9920

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": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1702944000000",
    "number": "1578643003",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10515 CARNEGIE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441063016",
            "telephone_number": "216-928-0136",
            "fax_number": "216-928-0141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10515 CARNEGIE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441063016",
            "telephone_number": "216-928-0136",
            "fax_number": "216-928-0141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "22715 Fairview Center Dr",
            "address_purpose": "LOCATION",
            "city": "Fairview Park",
            "state": "OH",
            "postal_code": "441263608",
            "country_code": "US",
            "telephone_number": "440-777-8400",
            "fax_number": "440-579-0167",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GEMBUS",
        "first_name": "SANDRA",
        "credential": "C.R.N.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-17",
        "last_updated": "2023-12-19",
        "certification_date": "2023-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN211887",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "041899",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000127087",
            "state": "OH"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "430036930",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0903919",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 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.