Individual provider Active NPI

Dewayne R Williams, C.R.N.A.

  • Certified Registered Nurse Anesthetist
  • Marion, OH
National Provider Identifier
1790727915
Registry record updated Oct 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
NA08622 Issued in OH
Practice address
1050 Delaware Ave
Marion, OH 43302-6416
Phone
(740) 383-7778
Fax
(740) 383-7942
NPI assigned
Jun 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2014

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 NA08622 OH Primary

Addresses

Primary practice location

1050 Delaware Ave
Marion, OH 43302-6416

Mailing address

1050 Delaware Ave
Marion, OH 43302-6416
Phone (740) 383-7778

Other identifiers 1

IdentifierTypeStateIssuer
2638391MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20060106000369 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 8123041076 Reassigns benefits to 1 organization
I20220517001558 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 8123041076 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
NA08622OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Marion Area Physicians LLC CurrentSince Oct 28, 2012 Accepting new patients
Space Coast Anesthesia Services LLC CurrentSince Aug 1, 2022 Accepting new patients
Orange City Anesthesia Services LLC CurrentSince Aug 1, 2022 Accepting new patients
Sarasota Ambulatory Surgery Center LTD Current Accepting new patients
Sarasota Anesthesia Services LLC CurrentSince Aug 1, 2022 Accepting new patients
Deperro Plastic Surgery, LLC Past Accepting new patients
Midwest Physician Anesthesia Services, Inc. Nurse Anesthetist, Certified Registered Past Accepting new patients
Anesthesiology Consultants of Toledo, Inc Past Accepting new patients

Locations

595 N Courtenay Pkwy
Ste 103
Merritt Island, FL 32953
Phone (321) 890-1800

975 Town Center Dr
Ste 100
Orange City, FL 32763
Phone (386) 456-5247

2821 Proctor Rd
Sarasota, FL 34231
Phone (941) 870-1872

Dept L3652
Columbus, OH 43260

921 E Franklin St
Kenton, OH 43326
Phone (419) 673-0761

1050 Delaware Ave
Marion, OH 43302
Phone (740) 383-7038

1040 Delaware Ave
Marion, OH 43302
Phone (330) 256-9874

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

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.

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1412640000000",
    "number": "1790727915",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 DELAWARE AVE",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433026416",
            "telephone_number": "740-383-7778"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 DELAWARE AVE",
            "city": "MARION",
            "state": "OH",
            "postal_code": "433026416",
            "telephone_number": "740-383-7778",
            "fax_number": "740-383-7942"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "DEWAYNE",
        "middle_name": "R",
        "credential": "C.R.N.A.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-12",
        "last_updated": "2014-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "NA08622",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2638391",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Marion, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2014; 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.