Individual provider Active NPI

Diane Soem, CRNA

  • Certified Registered Nurse Anesthetist
  • Burlington, MA
National Provider Identifier
1609191667
Registry record updated Sep 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
271109 Issued in MA
Practice address
41 Mall Rd
Lahey Clinic
Burlington, MA 01805-0001
Phone
(781) 744-8132
Fax
(781) 744-2273
NPI assigned
Apr 2, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2013

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 271109 MA Primary

Addresses

Primary practice location

41 Mall Rd
Lahey Clinic
Burlington, MA 01805-0001

Mailing address

41 Mall Rd
Lahey Clinic
Burlington, MA 01805-0001
Phone (781) 744-8132

Other names 1

  • Diane Konesavanh Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100927000442 MA Practitioner - Certified Registered Nurse Anesthetist (Crna) 8426174517 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lowell Anesthesiology Service IncGroup PAC ID 3072556141, 98 clinicians

Practice addresses (Care Compare)

33 Bartlett St
Suite 203
Lowell, MA 01852-1317
Phone (978) 689-4601

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Lahey Clinic, Inc Current Accepting new patients
Digestive Health Specialists, P.C. CurrentSince Jul 1, 2016 Accepting new patients
Lowell Anesthesiology Service, Inc. CurrentSince Jul 30, 2019 Accepting new patients
Lahey Clinic, Inc. CurrentSince Apr 29, 2013 Accepting new patients
Lowell Anesthesia Associates PLLC Nurse Anesthetist, Certified Registered CurrentSince Sep 28, 2017 Accepting new patients
Integrated Gastroenterology Consultants, PC Past Accepting new patients

Locations

41 Mall Rd
Burlington, MA 01805
Phone (781) 744-8400

4 Meeting House Rd
Ste 68
Chelmsford, MA 01824
Phone (978) 454-9811

59 Lowes Way
Lowell, MA 01851
Phone (617) 733-4166

33 Bartlett St
Ste 203
Lowell, MA 01852
Phone (978) 689-4601

Interoperability endpoints

  • FHIR API: https://7dd4c9b2-8c33-42e8-9be4-1fef2411298a.gastro.prod.fhir.ema-api.com/fhir/r4/

Organizations & group practices 6

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 1

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": "1270166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379376000000",
    "number": "1609191667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "41 MALL RD",
            "address_2": "LAHEY CLINIC",
            "city": "BURLINGTON",
            "state": "MA",
            "postal_code": "018050001",
            "telephone_number": "781-744-8132",
            "fax_number": "781-744-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 MALL RD",
            "address_2": "LAHEY CLINIC",
            "city": "BURLINGTON",
            "state": "MA",
            "postal_code": "018050001",
            "telephone_number": "781-744-8132",
            "fax_number": "781-744-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOEM",
        "first_name": "DIANE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-04-02",
        "last_updated": "2013-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MA",
            "license": "271109",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DIANE",
            "last_name": "KONESAVANH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Burlington, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2013; 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.