Rachel Renee Wallace, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Cortez, CO
NPI 1669719175 · NPPES record last updated Aug 8, 2022
Key facts
- NPI
- 1669719175
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- C-APN.0001428-C-CRNA (CO)
- Practice address
- 1311 N Mildred Rd
Cortez, CO 81321 - Phone
- (970) 555-6666
- NPI assigned
- Jan 4, 2013
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 7
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Novus Colorado Professional Corporation
Animas Anesthesia Associates LLC
Practice addresses (Care Compare)
1311 N Mildred Rd
Cortez, CO 81321-2231
Phone (800) 475-6236
2 Burnett CT
Durango, CO 81301-3647
Phone (970) 385-4022
Hospital & facility affiliations
- Southwest Memorial Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in SC, CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20151210000489 | SC | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 6204081656 | Reassigns benefits to 2 organizations |
| I20190617000691 | CO | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 6204081656 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C-APN.0001428-C-CRNA | CO | MD | Certified Registered Nurse Anesthetist |
| R0088890 | OK | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Animas Anesthesia Associates LLC | Current |
Accepting new patients | |
| Durango Surgery Center LLC | Current |
Accepting new patients | |
| Animas Surgical Hospital, LLC | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Medstream Anesthesia PLLC | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Novus Colorado Professional Corporation | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Coastal Healthcare Resources Inc | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Anesthesia Network Services, LLC | Past | Accepting new patients |
Locations
1311 N Mildred Rd
Cortez, CO 81321
Phone (970) 565-6666
575 Rivergate Ln
Durango, CO 81301
Phone (719) 648-5678
1266 Escalante Dr
Ste 101
Durango, CO 81303
Phone (248) 396-8109
2 Burnett Ct
Ste 200
Durango, CO 81301
Phone (970) 247-3537
2 Burnett Ct
Durango, CO 81301
Phone (970) 385-4022
3545 Highway 17
Murrells Inlt, SC 29576
Phone (843) 294-1941
2669 Kinard St
Newberry, SC 29108
Phone (803) 276-7570
501 Robertson Blvd
Walterboro, SC 29488
Phone (843) 549-2000
6330 S Western Ave
Ste 150
Sioux Falls, SD 57108
6128 S Lyncrest Ave
Sioux Falls, SD 57108
Phone (605) 334-1363
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | R0088890 | OK | |
| Certified Registered Nurse Anesthetist | 367500000X | C-APN.0001428-C-CRNA | CO | Yes |
Addresses
Primary practice location
1311 N Mildred Rd
Cortez, CO 81321
Mailing address
35505 Road K.1
Mancos, CO 81328-8978
Other practice location 1
35505 Road K.1
Mancos, CO 81328-8978
Phone (918) 284-2163
Other practice location 2
1311 N Mildred Rd
Cortez, CO 81321
Phone (970) 555-6666
Other practice location 3
6839 S Canton Ave
Tulsa, OK 74136-3402
Phone (918) 494-0612
Other providers in Cortez, CO
- Wal-Mart Stores, Inc.
- Walgreen Co
- Walgreen Co.
- Edward Stuart Walker
- Wallace Anesthesia Services Incorporated
- Walmart Inc.
- Liching Pi Wang
- Crystal Ward
- Kimberly Ann Washburn
- Jane Henninger Weiland
All providers in Cortez, CO · Certified Registered Nurse Anesthetist in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 8, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.