Individual provider Active NPI

Dustin M. Ambler, CRNA

  • Certified Registered Nurse Anesthetist
  • Jefferson City, MO
National Provider Identifier
1780673194
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
154946 Issued in MO
Practice address
1445 Christy Dr
Jefferson City, MO 65101-2853
Phone
(573) 636-3483
Fax
(573) 636-5315
NPI assigned
Oct 18, 2005
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 154946 MO Primary

Addresses

Primary practice location

1445 Christy Dr
Jefferson City, MO 65101-2853

Mailing address

525 Couch Ave
St. Joe Hospital of Kirkwood
Kirkwood, MO 63122-5536
Phone (573) 636-3483

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040825001354 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 3072599786 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Metro-West Anesthesia Group IncGroup PAC ID 2163329921, 204 clinicians

Practice addresses (Care Compare)

12303 De Paul Dr
Bridgeton, MO 63044-2512
Phone (314) 344-6000

2345 Dougherty Ferry Rd
Saint Louis, MO 63122-3313
Phone (314) 453-0600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Metro-West Anesthesia Group Inc Nurse Anesthetist, Certified Registered CurrentSince Jul 31, 2011 Accepting new patients
Northwest Anesthesia LTD Past Accepting new patients
Mid-Missouri Anesthesia Consultants PC PastSince Jul 1, 1996 Accepting new patients
Rosebud Indian Health Service Past Accepting new patients
Pine Ridge Indian Health Service Hospital Past Accepting new patients

Locations

2345 Dougherty Ferry Rd
Saint Louis, MO 63122
Phone (314) 821-5850

525 Couch Ave
Saint Louis, MO 63122
Phone (314) 317-9960

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1129593600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1780673194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 COUCH AVE",
            "address_2": "ST. JOE HOSPITAL OF KIRKWOOD",
            "city": "KIRKWOOD",
            "state": "MO",
            "postal_code": "631225536",
            "telephone_number": "573-636-3483",
            "fax_number": "573-636-5315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 CHRISTY DR",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651012853",
            "telephone_number": "573-636-3483",
            "fax_number": "573-636-5315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBLER",
        "first_name": "DUSTIN",
        "middle_name": "M.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-18",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "154946",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.