Individual provider Active NPI

Bobby James Humble, CRNA

  • Certified Registered Nurse Anesthetist
  • Slidell, LA
National Provider Identifier
1699733980
Registry record updated Jan 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
722279 Issued in TX
Practice address
100 Medical Center Drive
Slidell, LA 70461-5520
Phone
(713) 790-1349
Fax
(713) 790-0028
NPI assigned
May 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 5, 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 722279 TX Primary

Addresses

Primary practice location

100 Medical Center Drive
Slidell, LA 70461-5520

Mailing address

100 Medical Center Drive
Slidell, LA 70461-5520
Phone (985) 649-7070

Other identifiers 2

IdentifierTypeStateIssuer
02583005MedicaidMS
1390534MedicaidLA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060413000114 LA Practitioner - Certified Registered Nurse Anesthetist (Crna) 5799794129 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
722279TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Ochsner Clinic LLC CurrentSince May 1, 2010 Accepting new patients
Ochsner Clinic LLC CurrentSince May 1, 2010 Accepting new patients
Louisiana Anesthesia Partners, LLC Past Accepting new patients
Meadowcrest Multi-Specialty Clinic, LLC Past Accepting new patients

Locations

180 W Esplanade Ave
Kenner, LA 70065
Phone (504) 464-8284

1514 Jefferson Hwy
New Orleans, LA 70121

2750 Gause Blvd E
Slidell, LA 70461

100 Medical Center Dr
Slidell, LA 70461
Phone (504) 392-3131

Organizations & group practices 4

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": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1294185600000",
    "number": "1699733980",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 MEDICAL CENTER DRIVE",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704615520",
            "telephone_number": "985-649-7070",
            "fax_number": "713-790-0028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL CENTER DRIVE",
            "city": "SLIDELL",
            "state": "LA",
            "postal_code": "704615520",
            "telephone_number": "713-790-1349",
            "fax_number": "713-790-0028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUMBLE",
        "first_name": "BOBBY",
        "middle_name": "JAMES",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2011-01-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "722279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02583005",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1390534",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Slidell, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.