Individual provider Active NPI

Tonya L Draves-Wagner, CRNA

  • Certified Registered Nurse Anesthetist
  • St. Louis, MO
National Provider Identifier
1629269337
Registry record updated May 2, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
2003021073 Issued in MO
Practice address
525 Couch Ave
St. Louis, MO 63122
Phone
(314) 966-1500
NPI assigned
Aug 7, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2008

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 2003021073 MO Primary

Addresses

Primary practice location

525 Couch Ave
St. Louis, MO 63122

Mailing address

13523 Barrett Parkway Dr
Ste 210
Ballwin, MO 63021-3802
Phone (314) 775-2816

Other identifiers 1

IdentifierTypeStateIssuer
916300908MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071102000357 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 3779670047 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Metro-West Anesthesia Group IncGroup PAC ID 2163329921, 204 clinicians

Practice addresses (Care Compare)

1015 Bowles Ave
Fenton, MO 63026-2394
Phone (636) 496-2000

2345 Dougherty Ferry Rd
Saint Louis, MO 63122-3313
Phone (314) 453-0600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2003021073MOMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Metro-West Anesthesia Group Inc Nurse Anesthetist, Certified Registered CurrentSince Sep 5, 2007 Accepting new patients
Universtiy Anesthesia Assoc., Inc. Past Accepting new patients

Locations

400 S Woods Mill Rd
Ste 140
Chesterfield, MO 63017
Phone (314) 485-1101

525 Couch Ave
Saint Louis, MO 63122
Phone (314) 317-9960

2345 Dougherty Ferry Rd
Saint Louis, MO 63122
Phone (314) 821-5850

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 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": "1186444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1209686400000",
    "number": "1629269337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13523 BARRETT PARKWAY DR",
            "address_2": "STE 210",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630213802",
            "telephone_number": "314-775-2816"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 COUCH AVE",
            "city": "ST. LOUIS",
            "state": "MO",
            "postal_code": "63122",
            "telephone_number": "314-966-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DRAVES-WAGNER",
        "first_name": "TONYA",
        "middle_name": "L",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-07",
        "last_updated": "2008-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2003021073",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "916300908",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in St. Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2008; 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.