Individual provider Active NPI

Deanna Mary Gish, CRNA

  • Certified Registered Nurse Anesthetist
  • Springfield, MO
National Provider Identifier
1639409394
Registry record updated Nov 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
2011040587 Issued in MO
Practice address
1235 E Cherokee St
Springfield, MO 65804-2203
Phone
(417) 820-2829
Fax
(417) 820-8852
NPI assigned
Dec 31, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2012

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 CTP-000120 AR
Certified Registered Nurse Anesthetist 367500000X 2011040587 MO Primary

Addresses

Primary practice location

1235 E Cherokee St
Springfield, MO 65804-2203

Mailing address

PO Box 2580
Springfield, MO 65801-2580
Phone (417) 829-4620

Other identifiers 4

IdentifierTypeStateIssuer
P01059535OtherMOMCR - RR
431560263OtherMOTRICARE
1639409394MedicaidMO
185881001MedicaidAR

Other names 1

  • Deanna Mary Edwards Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120312000869 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 4688853195 Reassigns benefits to 2 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
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians

Practice addresses (Care Compare)

100 Hospital Dr
Lebanon, MO 65536-9210
Phone (417) 553-6059

Hospital & facility affiliations

  • Mercy Hospital Springfield Hospital, Springfield, MO, CCN 260065

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CTP-000120ARMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Mercy Clinic Springfield Communities CurrentSince Feb 20, 2012 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Aug 1, 2013 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Feb 20, 2012 Accepting new patients

Locations

100 Hospital Dr
Lebanon, MO 65536
Phone (417) 533-6010

1605 Martin Springs Dr
Rolla, MO 65401
Phone (573) 458-6379

1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379

620 S Glenstone Ave
Springfield, MO 65802
Phone (417) 829-4215

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

Organizations & group practices 3

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 9

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": "1262217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354060800000",
    "number": "1639409394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2580",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658012580",
            "telephone_number": "417-829-4620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 E CHEROKEE ST",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658042203",
            "telephone_number": "417-820-2829",
            "fax_number": "417-820-8852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GISH",
        "first_name": "DEANNA",
        "middle_name": "MARY",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-31",
        "last_updated": "2012-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "CTP-000120",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2011040587",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MCR - RR",
            "identifier": "P01059535",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "431560263",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1639409394",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "185881001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DEANNA",
            "last_name": "EDWARDS",
            "middle_name": "MARY",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Springfield, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 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.