NPIMap

Organization Active NPI

Palo Duro Anesthesia PLLC

  • Certified Registered Nurse Anesthetist
  • Amarillo, TX
National Provider Identifier
1750916169
Registry record updated Mar 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
PALO DURO ANESTHESIA PLLC
Practice address
1900 Medi Park Dr
Amarillo, TX 79106-2187
Phone
(806) 355-9447
NPI assigned
Mar 5, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2020

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

Authorized official

Name
Jeffery M Green, CRNANPI 1205188372
Title
President/Ceo
Phone
(806) 206-6942

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 Primary

Addresses

Primary practice location

1900 Medi Park Dr
Amarillo, TX 79106-2187

Mailing address

211 Aoudad Ranch TRL
Amarillo, TX 79118-1441
Phone (806) 206-6942

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210520001631 TX Part B Supplier - Clinic/Group Practice 3779982913 Receives reassigned benefits from 6 practitioners
Practice locations: Amarillo, TX; Arlington, TX

National Provider Directory

National Provider Directory

Locations

1900 Medi Park Dr
Amarillo, TX 79106
Phone (806) 355-9447

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": "1583366400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583366400000",
    "number": "1750916169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "211 AOUDAD RANCH TRL",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791181441",
            "telephone_number": "806-206-6942"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 MEDI PARK DR",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791062187",
            "telephone_number": "806-355-9447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALO DURO ANESTHESIA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-03-05",
        "last_updated": "2020-03-05",
        "certification_date": "2020-03-05",
        "status": "A",
        "authorized_official_last_name": "GREEN",
        "authorized_official_first_name": "JEFFERY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "806-206-6942",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Amarillo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2020; 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.