Individual provider Active NPI

Jordan Emile Vidrine, SRNA

  • Certified Registered Nurse Anesthetist
  • Alexandria, LA
National Provider Identifier
1750129953
Registry record updated Nov 6, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
245328 Issued in LA
Practice address
3330 Masonic Dr
Alexandria, LA 71301-3841
Phone
(318) 487-1122
NPI assigned
Jul 20, 2024
Last updated
Nov 6, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 6, 2026

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 AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X 245328 LA Primary

Addresses

Primary practice location

3330 Masonic Dr
Alexandria, LA 71301-3841

Mailing address

1077 Timmy St
Ville Platte, LA 70586-7509
Phone (337) 230-4919

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20260210004248 LA Practitioner - Certified Registered Nurse Anesthetist (Crna) 9537648415 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2025
Medicare assignment
May accept Medicare assignment

Practice addresses (Care Compare)

1077 Timmy St
Ville Platte, LA 70586-7509

1444 Peterman Dr
Alexandria, LA 71301-3432

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN156033LAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Louisiana Anesthesia Consultants, Apmc CurrentSince Feb 1, 2026 Accepting new patients

Locations

1444 Peterman Dr
Alexandria, LA 71301
Phone (318) 442-5399

3330 Masonic Dr
Alexandria, LA 71301
Phone (318) 448-6917

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1721433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1793923200000",
    "number": "1750129953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1077 TIMMY ST",
            "city": "VILLE PLATTE",
            "state": "LA",
            "postal_code": "705867509",
            "telephone_number": "337-230-4919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3330 MASONIC DR",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713013841",
            "telephone_number": "318-487-1122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VIDRINE",
        "first_name": "JORDAN",
        "middle_name": "EMILE",
        "credential": "SRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-07-20",
        "last_updated": "2026-11-06",
        "certification_date": "2026-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "LA",
            "license": "245328",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2026; 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.