Individual provider Active NPI

Jaime Mertz

  • Certified Registered Nurse Anesthetist
  • Worland, WY
National Provider Identifier
1649610205
Registry record updated Jun 27, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
91655 Issued in WY
Practice address
400 S 15TH St
Worland, WY 82401-3531
Phone
(307) 347-3221
NPI assigned
Jun 27, 2013
Last updated
Jun 27, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2013

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 91655 WY Primary

Addresses

Primary practice location

400 S 15TH St
Worland, WY 82401-3531

Mailing address

810 Howell Ave
Worland, WY 82401-4025
Phone (307) 899-4625

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130829000132 WY Practitioner - Certified Registered Nurse Anesthetist (Crna) 2062655616 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Washakie Medical CenterGroup PAC ID 2466369301, 6 clinicians

Practice addresses (Care Compare)

400 S 15TH St
Worland, WY 82401-3531
Phone (307) 347-3221

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
91655WYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Banner Health Physicians West LLC CurrentSince May 8, 2017 Accepting new patients
Banner Health Physicians West LLC CurrentSince May 8, 2017 Accepting new patients
Washakie Medical Center CurrentSince Mar 6, 2019 Accepting new patients
Washakie Medical Center CurrentSince Mar 6, 2019 Accepting new patients

Locations

1115 Lane 12
Lovell, WY 82431
Phone (307) 548-2771

1106 Big Horn Ave
Worland, WY 82401
Phone (307) 347-3221

400 S 15th St
Worland, WY 82401
Phone (307) 347-3221

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372291200000",
    "number": "1649610205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 HOWELL AVE",
            "city": "WORLAND",
            "state": "WY",
            "postal_code": "824014025",
            "telephone_number": "307-899-4625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 S 15TH ST",
            "city": "WORLAND",
            "state": "WY",
            "postal_code": "824013531",
            "telephone_number": "307-347-3221"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MERTZ",
        "first_name": "JAIME",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-06-27",
        "last_updated": "2013-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WY",
            "license": "91655",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Worland, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2013; 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.