Individual provider Active NPI

Thomas Scott Sutton, CRNA

  • Certified Registered Nurse Anesthetist
  • Shreveport, LA
National Provider Identifier
1679695225
Registry record updated Aug 8, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
03817 Issued in LA
Practice address
3217 Mabel St
Shreveport, LA 71103-4022
Phone
(318) 631-9121
Fax
(318) 638-6018
NPI assigned
Apr 4, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2011

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 03817 LA Primary

Addresses

Primary practice location

3217 Mabel St
Shreveport, LA 71103-4022

Mailing address

3217 Mabel St
Shreveport, LA 71103-4022
Phone (318) 631-9121

Other identifiers 1

IdentifierTypeStateIssuer
1186376MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040621000125 LA Practitioner - Certified Registered Nurse Anesthetist (Crna) 5294710703 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Shreveport Sedation Associates, LLCGroup PAC ID 3173886736, 10 clinicians

Practice addresses (Care Compare)

3217 Mabel St
Shreveport, LA 71103-4022
Phone (318) 631-9121

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
03817LAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Shreveport Sedation Associates LLC Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2018 Accepting new patients
Anesthesia Dynamics LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 17, 2020 Accepting new patients
Med-Trans Corporation Past Accepting new patients

Locations

3220 N St NW
Washington, DC 20007
Phone (202) 338-6051

3217 Mabel St
Shreveport, LA 71103

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.

NPI Registry JSON

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

{
    "created_epoch": "1175644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312761600000",
    "number": "1679695225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3217 MABEL ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034022",
            "telephone_number": "318-631-9121",
            "fax_number": "318-638-6018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3217 MABEL ST",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711034022",
            "telephone_number": "318-631-9121",
            "fax_number": "318-638-6018"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUTTON",
        "first_name": "THOMAS",
        "middle_name": "SCOTT",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-04",
        "last_updated": "2011-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "LA",
            "license": "03817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1186376",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shreveport, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2011; 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.