Jacob David Sandefur, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

202214569CRNAPP Issued in OR

Practice address

900 Sunset Dr
La Grande, OR 97850-1387

Phone

(541) 963-8421

NPI assigned

Jun 8, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR, WA, CO3 enrollments

Enrollment records 3

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Evergreen Anesthesia Associates LLCGroup PAC ID 7113284530, 26 clinicians

Advanced Anesthesia Services PLLCGroup PAC ID 6608159017, 39 clinicians

Grande Ronde Hospital IncGroup PAC ID 0547170789, 97 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Kittitas Valley Community Hospital Hospital, Ellensburg, WA, CCN 501333
• Grande Ronde Hospital Hospital, La Grande, OR, CCN 381321

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Grande Ronde Hospital, Inc.

  • Critical Access Hospital
  • La Grande, OR
  • NPI 1467446195
  Medicare reassignment Care Compare group NPD
• Advanced Anesthesia Services, PLLC

  • Certified Registered Nurse Anesthetist
  • Bellevue, WA
  • NPI 1700211786

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Evergreen Anesthesia Associates, LLC

  • Certified Registered Nurse Anesthetist
  • Sunnyside, WA
  • NPI 1225575996

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Animas Surgical Hospital, LLC

  dba Animas Physician Network

  • Emergency Medicine Physician
  • Durango, CO
  • NPI 1861721714

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Grande Ronde Hospital, Inc.

  dba Grande Ronde Hospital Urgent Care

  • Rural Health Clinic/Center
  • La Grande, OR
  • NPI 1093296519
  NPD
• Animas Surgical Hospital, LLC

  dba Animas Urgent Care

  • Urgent Care Clinic/Center
  • Durango, CO
  • NPI 1194161422
  NPD
• Durango Surgery Center LLC

  dba Animas Surgical Center at Escalante

  • Ambulatory Surgical Clinic/Center
  • Durango, CO
  • NPI 1548870603
  NPD

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

• Grande Ronde Hospital

  dba Grande Ronde Hospital Childrens Clinic

  • Pediatrics Physician
  • La Grande, OR
  • NPI 1861434615

  Hospital

  Care Compare affiliation
• Grande Ronde Hospital Inc.

  dba Grande Ronde Hospital Womens Clinic

  • Obstetrics & Gynecology Physician
  • La Grande, OR
  • NPI 1972545895

  Hospital

  Care Compare affiliation
• Grande Ronde Hospital, Inc.

  dba Grande Ronde Hospital Internal Medicine Clinic

  • Primary Care Clinic/Center
  • La Grande, OR
  • NPI 1174553929

  Hospital

  Care Compare affiliation
• Grande Ronde Hospital, Inc.

  • Critical Access Hospital
  • La Grande, OR
  • NPI 1467446195
  Care Compare affiliation
• Kittitas County Public Hospital Dist 1

  dba Kittitas Valley Community Hospital

  • Critical Access Hospital
  • Ellensburg, WA
  • NPI 1356375307
  Care Compare affiliation

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

{
    "created_epoch": "1654646400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663891200000",
    "number": "1770212417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2302 E N CT",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978503858",
            "telephone_number": "541-519-0890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 SUNSET DR",
            "city": "LA GRANDE",
            "state": "OR",
            "postal_code": "978501387",
            "telephone_number": "541-963-8421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDEFUR",
        "first_name": "JACOB",
        "middle_name": "DAVID",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-06-08",
        "last_updated": "2022-09-23",
        "certification_date": "2022-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "239503",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OR",
            "license": "202214569CRNAPP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cynthia Russell, MSW
• Lori Russell
• Safeway Inc (Safeway Pharmacy #1827)
• Mark Sagaria
• Eileen L Salsig, MA
• John E Schaefer, MD
• Rachel Schaeffer
• Angela Schmeckpeper
• Ellen K Schoenfelder, MD
• Timothy Kaiser Schoenfelder, MD

• Certified Registered Nurse Anesthetist in La Grande, OR
• Providers in La Grande, OR by specialty
• Certified Registered Nurse Anesthetist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2022; 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.