Cassidy B Waterman, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

RNA-781 Issued in ID

Practice address

1950 E Clark St
Suite G
Pocatello, ID 83201-3314

Phone

(208) 232-7760

Fax

(208) 232-1950

NPI assigned

Oct 20, 2010

Sex

Male

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 3

Medicare fee-for-service enrollment

Enrolled in ID, NM2 enrollments

Enrollment records 2

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northstar Anesthesia of Idaho PLLCGroup PAC ID 6204283856, 37 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Portneuf Medical Center Hospital, Pocatello, ID, CCN 130028

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.

• Northstar Anesthesia of Idaho PLLC

  • Anesthesiology Physician
  • Pocatello, ID
  • NPI 1912686882
  Medicare reassignment Care Compare group NPD
• Northstar Anesthesia of New Mexico LLC

  • Anesthesiology Physician
  • Hobbs, NM
  • NPI 1710797949
  Medicare reassignment

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

• Pocatello Hospital LLC

  • Rehabilitation Hospital Unit
  • Pocatello, ID
  • NPI 1144262114
  Care Compare affiliation
• Pocatello Hospital LLC

  • General Acute Care Hospital
  • Pocatello, ID
  • NPI 1790751055
  Care Compare affiliation

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

{
    "created_epoch": "1287532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697673600000",
    "number": "1750691929",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "777 HOSPITAL WAY",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832015175",
            "telephone_number": "208-240-0735",
            "fax_number": "208-232-1950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1950 E CLARK ST",
            "address_2": "SUITE G",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832013314",
            "telephone_number": "208-232-7760",
            "fax_number": "208-232-1950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERMAN",
        "first_name": "CASSIDY",
        "middle_name": "B",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-20",
        "last_updated": "2023-10-19",
        "certification_date": "2023-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ID",
            "license": "RNA-781",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR GROUP LEGACY NUMBER",
            "identifier": "CD5673",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL RR MEDICARE",
            "identifier": "P00956855",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "1604930",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shayla F Ward, LPC
• Abigail Warner, PT, DPT
• Zachary Bryant Warnock, M.D.
• Carley Alison Warren
• Wynnona Sarah Warren, PHARMD
• Austin R Waters
• Richard A Wathne, MD
• Cynthia Watkins, LCPC-9996
• Stacie A Watkins
• Brian S Watson, PA-C

• Certified Registered Nurse Anesthetist in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Certified Registered Nurse Anesthetist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2023; 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.