Individual provider Active NPI

Wendy A Windham, CRNA

  • Certified Registered Nurse Anesthetist
  • Enterprise, AL
National Provider Identifier
1629035126
Registry record updated Oct 2, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1-053949 Issued in AL
Practice address
400 N Edwards St
Enterprise, AL 36330-2510
Phone
(334) 347-0584
NPI assigned
Apr 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 2, 2014

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 1-053949 AL Primary

Addresses

Primary practice location

400 N Edwards St
Enterprise, AL 36330-2510

Mailing address

400 N Edwards St
Enterprise, AL 36330-2510
Phone (334) 347-0584

Other identifiers 1

IdentifierTypeStateIssuer
009973270MedicaidAL

Other names 1

  • Wendy A Windham Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080225000143 AL Practitioner - Certified Registered Nurse Anesthetist (Crna) 8325122724 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gut PCGroup PAC ID 3375589799, 53 clinicians

Practice addresses (Care Compare)

1450 Ross Clark Cir
Suite 4
Dothan, AL 36301-4736
Phone (334) 836-1212

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1-053949ALMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Alabama Surgery Center LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2014 Accepting new patients
Gut PC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2017 Accepting new patients
Gut PC Current Accepting new patients
Epix Anesthesia of Alabama LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2016 Accepting new patients

Locations

400 E 10th St
Anniston, AL 36207
Phone (256) 235-5121

1450 Ross Clark Cir
Ste 4
Dothan, AL 36301
Phone (334) 699-7900

2800 Ross Clark Cir
Ste 3
Dothan, AL 36301
Phone (334) 793-3411

480 Honeysuckle Rd
Dothan, AL 36305
Phone (334) 792-6933

400 N Edwards St
Enterprise, AL 36330
Phone (334) 347-0584

Organizations & group practices 4

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": "1146096000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412208000000",
    "number": "1629035126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 N EDWARDS ST",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363302510",
            "telephone_number": "334-347-0584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 N EDWARDS ST",
            "city": "ENTERPRISE",
            "state": "AL",
            "postal_code": "363302510",
            "telephone_number": "334-347-0584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WINDHAM",
        "first_name": "WENDY",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-04-27",
        "last_updated": "2014-10-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AL",
            "license": "1-053949",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009973270",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "WENDY",
            "last_name": "WINDHAM",
            "middle_name": "A",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Enterprise, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2014; 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.