Sally J Pendergrass, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

R0050582 Issued in OK

Practice address

1923 S Utica Ave
Tulsa, OK 74104-6520

Phone

(918) 744-2345

NPI assigned

Jan 7, 2009

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 identifiers 2

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2008

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Olympia Anesthesia PLC 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tulsa Spine & Specialty Hospital Hospital, Tulsa, OK, CCN 370216

Medicare enrollment (NPD)

Enrolled

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 and National Provider Directory roles.

• Olympia Anesthesia, PLC

  • Anesthesiology Physician
  • Tulsa, OK
  • NPI 1205841186

  OK

  Medicare reassignment Care Compare group NPD

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

• Tulsa Spine & Specialty Hospital

  • General Acute Care Hospital
  • Tulsa, OK
  • NPI 1033185293

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1231286400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251158400000",
    "number": "1740427178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4500 S GARNETT RD",
            "address_2": "SUITE 300",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741465229",
            "telephone_number": "918-664-9892",
            "fax_number": "918-392-2945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1923 S UTICA AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741046520",
            "telephone_number": "918-744-2345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGRASS",
        "first_name": "SALLY",
        "middle_name": "J",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-07",
        "last_updated": "2009-08-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OK",
            "license": "R0050582",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200232940A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00731722",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ashley Jean Pena, MS
• Damaris Pena
• George Mumford Pendell III, M.D.
• Natalee Pendergraft, APRN
• Janece Pendergrass
• Paige Pendry, RN
• Malachi Thomas Penland
• Rodney Scott Penland
• Katie Penn, DO
• Mary J Penn, RPT

• All providers in Tulsa, OK
• Certified Registered Nurse Anesthetist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2009; 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.