Individual provider Active NPI

Leslie Ray Waltman III, CRNA

  • Certified Registered Nurse Anesthetist
  • Overland Park, KS
National Provider Identifier
1790053569
Registry record updated Feb 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
2012006261 Issued in MO
Practice address
8717 W 110TH St
Suite 600
Overland Park, KS 66210-2144
Phone
(205) 474-3208
NPI assigned
Dec 8, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 19, 2018

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 1-115596 AL
Certified Registered Nurse Anesthetist 367500000X 2012006261 MO Primary
Registered Nurse 163W00000X 2011040586 MO

Addresses

Primary practice location

8717 W 110TH St
Suite 600
Overland Park, KS 66210-2144

Mailing address

1308 E Briggs Dr
Macon, MO 63552-1919
Phone (660) 415-5215

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120410000691 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 7113188640 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
University of Alabama School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lake Ozark Anesthesia and Associates, IncGroup PAC ID 6305806530, 22 clinicians

Practice addresses (Care Compare)

54 Hospital Dr
Osage Beach, MO 65065-3050
Phone (573) 348-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
1-115596ALMDRegistered Nurse
2011040586MOMDRegistered Nurse
2012006261MOMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Lake Ozark Anesthesia & Associates, Inc CurrentSince Apr 2, 2018 Accepting new patients
Lake of the Ozarks Pain Management Services, Inc Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

54 Hospital Dr
Osage Beach, MO 65065
Phone (573) 280-2772

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1323302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1518998400000",
    "number": "1790053569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1308 E BRIGGS DR",
            "city": "MACON",
            "state": "MO",
            "postal_code": "635521919",
            "telephone_number": "660-415-5215"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8717 W 110TH ST",
            "address_2": "SUITE 600",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662102144",
            "telephone_number": "205-474-3208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTMAN",
        "first_name": "LESLIE",
        "middle_name": "RAY",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-08",
        "last_updated": "2018-02-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "1-115596",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2012006261",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2011040586",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Overland Park, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2018; 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.