NPIMap

Hendra Yosia Sitompul, CRNA

Individual provider Active NPI Certified Registered Nurse Anesthetist · Danville, KY

NPI 1780191031 · NPPES record last updated May 20, 2022

Key facts

NPI
1780191031
Entity type
Individual (NPI type 1)
Primary specialty
Certified Registered Nurse Anesthetist 367500000X
License
3011997 (KY)
Practice address
210 W Main St FL 2
Danville, KY 40422-1812
Phone
(859) 236-3726
Fax
(859) 236-3019
NPI assigned
Jan 9, 2018
Sex
Male
Sole proprietor
Yes

Organizations & group practices 8

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.

Hospital & facility affiliations 2

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

Medicare Care Compare profile

Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ephraim McDowell Health Resource Inc (161 clinicians)

Practice addresses (Care Compare)

216 W Walnut St
Suite a
Danville, KY 40422-1832
Phone (859) 239-5870

Hospital & facility affiliations

  • Ephraim McDowell Regional Medical Center Hospital · Danville, KY · CCN 180048

Merit-based Incentive Payment System (MIPS)

Final score
81.36 of 100 (group)
Quality
64.78
Promoting interoperability
100
Improvement activities
40
Cost
67.25

Medicare participation

Medicare fee-for-service enrollment
Enrolled in KY

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
I20180201001925 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 6800156340 Reassigns benefits to 4 organizations

National Provider Directory

Medicare enrollment (NPD)
Yes
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Ephraim McDowell Health Resource, Inc Current
since Jul 13, 2022		 Accepting new patients
Ephraim McDowell Health Resource, Inc. Current Accepting new patients
Danville Anesthesia Associates, LLP Nurse Anesthetist, Certified Registered Current
since Jan 12, 2018		 Accepting new patients
Ephraim McDowell Health Resource, Inc Nurse Anesthetist, Certified Registered Current
since Jul 13, 2022		 Accepting new patients
Madar Bux, M.D., P.S.C. Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

109 Daniel Dr
Danville, KY 40422
Phone (859) 236-3361

216 W Walnut St
Ste A
Danville, KY 40422
Phone (859) 239-5870

230 W Main St
Ste 200
Danville, KY 40422

217 S 3rd St
Danville, KY 40422
Phone (859) 239-1000

210 W Main St
Fl 2
Danville, KY 40422

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 3011997 KY Yes

Addresses

Primary practice location

210 W Main St FL 2
Danville, KY 40422-1812

Mailing address

PO Box 27766
Belfast, ME 04915-2029
Phone (888) 488-8289

Other practice location 1

217 S 3rd St
Danville, KY 40422-1823
Phone (909) 239-1000

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on May 20, 2022.

{
    "created_epoch": "1515456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1653004800000",
    "number": "1780191031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27766",
            "city": "BELFAST",
            "state": "ME",
            "postal_code": "049152029",
            "telephone_number": "888-488-8289",
            "fax_number": "502-919-9780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W MAIN ST FL 2",
            "city": "DANVILLE",
            "state": "KY",
            "postal_code": "404221812",
            "telephone_number": "859-236-3726",
            "fax_number": "859-236-3019"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "217 S 3rd St",
            "address_purpose": "LOCATION",
            "city": "Danville",
            "state": "KY",
            "postal_code": "404221823",
            "country_code": "US",
            "telephone_number": "909-239-1000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SITOMPUL",
        "first_name": "HENDRA",
        "middle_name": "YOSIA",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-09",
        "last_updated": "2022-05-20",
        "certification_date": "2022-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3011997",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Danville, KY

All providers in Danville, KY · Certified Registered Nurse Anesthetist in Kentucky

Sources for this page

Verify at the official NPI Registry.