NPIMap

Organization Active NPI

Poplar Bluff Regional Medical Center LLC

Doing business as Poplar Bluff CRNA

  • Certified Registered Nurse Anesthetist
  • Poplar Bluff, MO
National Provider Identifier
1730330168
Registry record updated Mar 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
POPLAR BLUFF REGIONAL MEDICAL CENTER LLC
Doing business as
Poplar Bluff CRNA
Practice address
2620 N Westwood Blvd
Poplar Bluff, MO 63901-3396
Phone
(573) 785-7500
NPI assigned
Oct 3, 2008
Last updated
Mar 16, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2012

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

Authorized official

Name
Linda A Epstein
Title
VP & Acting General Counsel
Phone
(239) 598-3131

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X NU Primary

Addresses

Primary practice location

2620 N Westwood Blvd
Poplar Bluff, MO 63901-3396

Mailing address

PO Box 3937
Poplar Bluff, MO 63902-3937
Phone (573) 785-7500

Other names 1

  • Poplar Bluff CRNA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090911000300 MO Part B Supplier - Clinic/Group Practice 6800707225 Receives reassigned benefits from 14 practitioners
7 other NPIs on this enrollment
Practice locations: Poplar Bluff, MO; Dexter, MO; Malden, MO; Bloomfield, MO

Other NPIs with the same Medicare PAC ID 7

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 7

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1222992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331856000000",
    "number": "1730330168",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3937",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639023937",
            "telephone_number": "573-785-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013396",
            "telephone_number": "573-785-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POPLAR BLUFF REGIONAL MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-03",
        "last_updated": "2012-03-16",
        "status": "A",
        "authorized_official_last_name": "EPSTEIN",
        "authorized_official_first_name": "LINDA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "VP & ACTING GENERAL COUNSEL",
        "authorized_official_telephone_number": "239-598-3131"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Poplar Bluff CRNA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Poplar Bluff, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2012; 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.