Elizabeth Koob Clyne, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

2002001428 Issued in MO

Practice address

12634 Olive Blvd
Saint Louis, MO 63141-6337

Phone

(314) 996-8378

Fax

(314) 996-8910

NPI assigned

May 25, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Eye Anesthesia LLCGroup PAC ID 5698922581, 10 clinicians

Viking Anesthesia Services LLCGroup PAC ID 8628393972, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Eye Anesthesia LLC

  • Anesthesiology Physician
  • Saint Louis, MO
  • NPI 1528334182
  Medicare reassignment Care Compare group NPD
• Viking Anesthesia Services, LLC

  • Anesthesiology Physician
  • Creve Coeur, MO
  • NPI 1962809244
  Medicare reassignment Care Compare group NPD
• Gateway Anesthesia Group LLC

  • Anesthesiology Physician
  • Saint Louis, MO
  • NPI 1457040479
  Medicare reassignment NPD
• Metro-West Anesthesia Group Inc

  • Anesthesiology Physician
  • Chesterfield, MO
  • NPI 1245427335

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• SW Anesthesia LLC

  • Anesthesiology Physician
  • Saint Louis, MO
  • NPI 1306319769
  Medicare reassignment NPD
• Northwest Anesthesia LTD

  • Anesthesiology Physician
  • Bridgeton, MO
  • NPI 1114917374
  NPD (past)

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1352332800000",
    "number": "1679529655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 S EUCLID AVE",
            "address_2": "C B 8054",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101010",
            "telephone_number": "314-996-8378",
            "fax_number": "314-996-8910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12634 OLIVE BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631416337",
            "telephone_number": "314-996-8378",
            "fax_number": "314-996-8910"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOOB CLYNE",
        "first_name": "ELIZABETH",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2012-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2002001428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600420060",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sarah Jane Konopka, MS CCC-SLP
• Steven Gerard Konopka, LCSW
• Katerina Sunn Konstantinoff, MD
• Kevin L Konzen, MD
• Michele Koo, M.D.
• Ashley Koon, NP
• Danielle S Koonce, PNP
• Laura Susan Koopman, DO
• Andrew Stephen Koopmeiners, M.D.
• Christine L Kooser, NCMT, LMT

• Certified Registered Nurse Anesthetist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Certified Registered Nurse Anesthetist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 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.