Keisha R. Church, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

R168546 Issued in MD

Practice address

1200 Granada St
Accokeek, MD 20607-3026

Phone

(301) 203-6462

Fax

(301) 203-0317

NPI assigned

Dec 4, 2009

Last updated

Apr 27, 2012By the provider in NPPES

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 names 1

• Keisha D. Hackley Former name

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dominion Anesthesia PLLCGroup PAC ID 7618863713, 73 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Virginia Hospital Center Hospital, Arlington, VA, CCN 490050

Merit-based Incentive Payment System (MIPS)

Final score

82.6 of 100Reported as group

Quality

81.55

Improvement activities

40

Cost

75.84

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

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

• Dominion Anesthesia, PLLC

  • Anesthesiology Physician
  • Arlington, VA
  • NPI 1073554952

  DC, Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Virginia Hospital Center Arlington Health System

  • General Acute Care Hospital
  • Arlington, VA
  • NPI 1790785996
  Care Compare affiliation

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

{
    "created_epoch": "1259884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1335484800000",
    "number": "1679801419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 GRANADA ST",
            "city": "ACCOKEEK",
            "state": "MD",
            "postal_code": "206073026",
            "telephone_number": "301-203-6462",
            "fax_number": "301-203-0317"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 GRANADA ST",
            "city": "ACCOKEEK",
            "state": "MD",
            "postal_code": "206073026",
            "telephone_number": "301-203-6462",
            "fax_number": "301-203-0317"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "KEISHA",
        "middle_name": "R.",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-04",
        "last_updated": "2012-04-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MD",
            "license": "R168546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEISHA",
            "last_name": "HACKLEY",
            "middle_name": "D.",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Certified Registered Nurse Anesthetist in Accokeek, MD
• Providers in Accokeek, MD by specialty
• Certified Registered Nurse Anesthetist in Maryland

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