Individual provider Active NPI

Ajay Kumar Mishra

  • Certified Registered Nurse Anesthetist
  • Waco, TX
National Provider Identifier
1710475215
Registry record updated Jul 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
AP138121 Issued in TX
Practice address
100 Hillcrest Medical Blvd
Waco, TX 76712
Phone
(254) 202-2000
NPI assigned
Apr 30, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 11, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 939667 TX
Certified Registered Nurse Anesthetist 367500000X AP138121 TX Primary

Addresses

Primary practice location

100 Hillcrest Medical Blvd
Waco, TX 76712

Mailing address

PO Box 844658
Dallas, TX 75284-4658

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180912000961 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 5496005415 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northstar Anesthesia PAGroup PAC ID 7315907128, 231 clinicians
Emergenchealth PLLCGroup PAC ID 1355606641, 1,037 clinicians

Practice addresses (Care Compare)

2201 Clear Creek Rd
Killeen, TX 76549-4110
Phone (254) 526-7523

6200 W Parker Rd
Plano, TX 75093-7939
Phone (972) 608-8000

850 Ed Hall Dr
Texas Health Kaufman
Kaufman, TX 75142-1861
Phone (972) 932-7378

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
939667TXMDCritical Care Medicine Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Endo Sedation LLC Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2022 Accepting new patients
Northstar Anesthesia, PA Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2023 Accepting new patients
Endo Sedation LLC Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2022 Accepting new patients
Emergenchealth PLLC Nurse Anesthetist, Certified Registered CurrentSince Jan 20, 2024 Accepting new patients
Endo Sedation LLC Nurse Anesthetist, Certified Registered Current Accepting new patients

Locations

1411 Medical Pkwy
Ste 100
Cedar Park, TX 78613
Phone (512) 528-2000

1001 Surrey Ln
Flower Mound, TX 75022
Phone (817) 337-3671

909 9th Ave
Ft Worth, TX 76104
Phone (817) 336-6060

1917 Ashland St
Houston, TX 77008
Phone (713) 861-6161

850 Ed Hall Dr
Kaufman, TX 75142
Phone (972) 932-5555

6200 W Parker Rd
Plano, TX 75093
Phone (972) 608-8000

7400 Barlite Blvd
San Antonio, TX 78224
Phone (210) 921-2000

Organizations & group practices 5

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1525046400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657497600000",
    "number": "1710475215",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 844658",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752844658"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HILLCREST MEDICAL BLVD",
            "city": "WACO",
            "state": "TX",
            "postal_code": "76712",
            "telephone_number": "254-202-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MISHRA",
        "first_name": "AJAY",
        "middle_name": "KUMAR",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-30",
        "last_updated": "2022-07-11",
        "certification_date": "2022-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "TX",
            "license": "939667",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "AP138121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waco, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2022; 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.