Individual provider Active NPI

Amber Nicole Hines, CRNA

  • Certified Registered Nurse Anesthetist
  • Waterloo, IA
National Provider Identifier
1629232855
Registry record updated Mar 29, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
D-110691 Issued in IA
Practice address
1825 Logan Ave
Waterloo, IA 50703-1916
Phone
(319) 235-5386
Fax
(319) 235-3074
NPI assigned
Jul 16, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 29, 2012

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 110691 IA
Certified Registered Nurse Anesthetist 367500000X D-110691 IA Primary

Addresses

Primary practice location

1825 Logan Ave
Waterloo, IA 50703-1916

Mailing address

4150 Kimball Ave
PO Box 2758
Waterloo, IA 50701-9086
Phone (319) 235-5390

Other identifiers 1

IdentifierTypeStateIssuer
1629232855MedicaidIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120125000928 IA Practitioner - Certified Registered Nurse Anesthetist (Crna) 7810164282 Reassigns benefits to 4 organizations

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

Practice addresses (Care Compare)

201 E J Ave
Grundy Center, IA 50638-2028
Phone (319) 824-5421

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
93.78 of 100Reported as apm
Quality
80.38
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
110691IAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Medical Center New Hampton Current Accepting new patients
Waverly Health Center CurrentSince Jul 14, 2014 Accepting new patients
Grundy County Memorial Hospital Current Accepting new patients
Waverly Health Center Nurse Anesthetist, Certified Registered CurrentSince Jul 14, 2014 Accepting new patients

Locations

201 E J Ave
Grundy Center, IA 50638
Phone (319) 824-5081

312 9th St SW
Waverly, IA 50677
Phone (319) 352-4120

Organizations & group practices 5

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": "1216166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332979200000",
    "number": "1629232855",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4150 KIMBALL AVE",
            "address_2": "PO BOX 2758",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507019086",
            "telephone_number": "319-235-5390",
            "fax_number": "319-235-5607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1825 LOGAN AVE",
            "city": "WATERLOO",
            "state": "IA",
            "postal_code": "507031916",
            "telephone_number": "319-235-5386",
            "fax_number": "319-235-3074"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HINES",
        "first_name": "AMBER",
        "middle_name": "NICOLE",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-07-16",
        "last_updated": "2012-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IA",
            "license": "110691",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IA",
            "license": "D-110691",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629232855",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Waterloo, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2012; 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.