NPIMap

Organization Active NPI

Noble Dreams Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Salem, OR
National Provider Identifier
1750889804
Registry record updated Nov 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
201392028CRNA Issued in OR
Legal business name
NOBLE DREAMS ANESTHESIA LLC
Practice address
3099 River Rd S # 100
Salem, OR 97302-9754
Phone
(503) 758-0892
Fax
(503) 966-1177
NPI assigned
Jan 23, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 10, 2025

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

Authorized official

Name
Tyson Summers, CRNANPI 1679907323
Title
Organizer/Chief Manager
Phone
(865) 384-6465

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X 201392028CRNA OR Primary

Addresses

Primary practice location

3099 River Rd S # 100
Salem, OR 97302-9754

Mailing address

3473 Maci Elle CT SE
Salem, OR 97302-2797
Phone (865) 384-6465

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180228002482 OR Part B Supplier - Clinic/Group Practice 5698036945 Receives reassigned benefits from 6 practitioners
Practice locations: McMinnville, OR; Salem, OR

National Provider Directory

National Provider Directory

Locations

3099 River Rd S
#100
Salem, OR 97302
Phone (503) 361-3094

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1516665600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762732800000",
    "number": "1750889804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3473 MACI ELLE CT SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973022797",
            "telephone_number": "865-384-6465"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3099 RIVER RD S # 100",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973029754",
            "telephone_number": "503-758-0892",
            "fax_number": "503-966-1177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NOBLE DREAMS ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-01-23",
        "last_updated": "2025-11-10",
        "certification_date": "2025-11-10",
        "status": "A",
        "authorized_official_last_name": "SUMMERS",
        "authorized_official_first_name": "TYSON",
        "authorized_official_title_or_position": "ORGANIZER/CHIEF MANAGER",
        "authorized_official_telephone_number": "865-384-6465",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OR",
            "license": "201392028CRNA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Salem, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2025; 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.