Individual provider Active NPI

Anthony Wanjohi Nderitu, CRNA

  • Certified Registered Nurse Anesthetist
  • Phoenix, AZ
National Provider Identifier
1629366802
Registry record updated Jan 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
CRNA1078 Issued in AZ
Practice address
1850 N Central Ave
Suite 1600
Phoenix, AZ 85004-4527
Phone
(602) 262-8900
NPI assigned
Jul 21, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 2004022872 MO
Certified Registered Nurse Anesthetist 367500000X CRNA1078 AZ Primary

Addresses

Primary practice location

1850 N Central Ave
Suite 1600
Phoenix, AZ 85004-4527

Mailing address

13629 W Evans Dr
Surprise, AZ 85379-8349
Phone (417) 396-0013

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150221000192 AZ Practitioner - Certified Registered Nurse Anesthetist (Crna) 7618146895 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Valley Anesthesiology Consultants IncGroup PAC ID 4880591841, 284 clinicians

Practice addresses (Care Compare)

5555 W Thunderbird Rd
Glendale, AZ 85306-4622
Phone (602) 865-5555

Hospital & facility affiliations

  • Banner Estrella Medical Center Hospital, Phoenix, AZ, CCN 030115

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CRNA1078AZMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
East Valley Endoscopy LLC PastSince Jun 7, 2016 Accepting new patients

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": "1311206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610409600000",
    "number": "1629366802",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13629 W EVANS DR",
            "city": "SURPRISE",
            "state": "AZ",
            "postal_code": "853798349",
            "telephone_number": "417-396-0013",
            "fax_number": "602-262-8890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 N CENTRAL AVE",
            "address_2": "SUITE 1600",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850044527",
            "telephone_number": "602-262-8900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NDERITU",
        "first_name": "ANTHONY",
        "middle_name": "WANJOHI",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-07-21",
        "last_updated": "2021-01-12",
        "certification_date": "2021-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2004022872",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AZ",
            "license": "CRNA1078",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Phoenix, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2021; 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.