Individual provider Active NPI

Samuel Kyle Pendleton, CRNA

  • Certified Registered Nurse Anesthetist
  • Abilene, TX
National Provider Identifier
1578676946
Registry record updated Nov 1, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
674937 Issued in TX
Practice address
6250 US Highway 83
Abilene, TX 79606-5215
Phone
(325) 428-1000
NPI assigned
Aug 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 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 674937 TX Primary

Addresses

Primary practice location

6250 US Highway 83
Abilene, TX 79606-5215

Mailing address

189 Lake Ridge Rd
Tuscola, TX 79562-3662
Phone (325) 572-4097

Other identifiers 1

IdentifierTypeStateIssuer
87985UOtherTXBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071002000370 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 4486749793 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergenchealth PLLCGroup PAC ID 1355606641, 1,037 clinicians

Practice addresses (Care Compare)

6250 US Hwy 83
Suite 84
Abilene, TX 79606-5215
Phone (325) 428-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
674937TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Youngs Professional Services LLC Nurse Anesthetist, Certified Registered CurrentSince Oct 29, 2018 Accepting new patients
Emergenchealth PLLC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2019 Accepting new patients

Locations

6250 US Highway 83
#84
Abilene, TX 79606

7777 Forest Ln
Dallas, TX 75230
Phone (972) 566-7283

130 Hays St
Luling, TX 78648
Phone (830) 875-7000

500 W 4th St
Odessa, TX 79761
Phone (432) 640-1000

401 W Campbell Rd
Richardson, TX 75080
Phone (940) 384-3535

7400 Barlite Blvd
San Antonio, TX 78224
Phone (210) 921-2000

7909 Fredericksburg Rd
San Antonio, TX 78229
Phone (210) 437-0884

1305 Wonder World Dr
Ste 105
San Marcos, TX 78666
Phone (512) 353-8161

Organizations & group practices 2

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": "1155772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193875200000",
    "number": "1578676946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 LAKE RIDGE RD",
            "city": "TUSCOLA",
            "state": "TX",
            "postal_code": "795623662",
            "telephone_number": "325-572-4097"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6250 US HIGHWAY 83",
            "city": "ABILENE",
            "state": "TX",
            "postal_code": "796065215",
            "telephone_number": "325-428-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDLETON",
        "first_name": "SAMUEL",
        "middle_name": "KYLE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-17",
        "last_updated": "2007-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "674937",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "87985U",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Abilene, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2007; 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.