Individual provider Active NPI

Samuel Lecates, CRNA

  • Certified Registered Nurse Anesthetist
  • Forest, VA
National Provider Identifier
1790788396
Registry record updated Aug 4, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
151711 Issued in VA
Practice address
1834 Graves Mill Rd
Forest, VA 24551
Phone
(800) 277-8151
Fax
(336) 841-6217
NPI assigned
May 27, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 110650 NC
Certified Registered Nurse Anesthetist 367500000X 151711 VA Primary

Addresses

Primary practice location

1834 Graves Mill Rd
Forest, VA 24551

Mailing address

PO Box 14489
Archdale, NC 27263-7489
Phone (800) 277-8151

Other identifiers 1

IdentifierTypeStateIssuer
010029601MedicaidVA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, VA, GA, NC4 enrollments

Enrollment records 4

Enrollment IDStateProvider typePAC IDDetails
I20080128000087 SC Practitioner - Certified Registered Nurse Anesthetist (Crna) 6608893086 Reassigns benefits to 1 organization
I20090305000527 VA Practitioner - Certified Registered Nurse Anesthetist (Crna) 6608893086 Reassigns benefits to 2 organizations
I20090708000436 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 6608893086 Reassigns benefits to 1 organization
I20090813000347 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 6608893086 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Care Services PAGroup PAC ID 7012937105, 54 clinicians

Practice addresses (Care Compare)

2109 Valleygate Dr
Suite 201
Fayetteville, NC 28304-3571
Phone (910) 486-8880

Merit-based Incentive Payment System (MIPS)

Final score
73.38 of 100Reported as group
Quality
77.5
Improvement activities
20

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3318SCMDChiropractor
466NCMDAcupuncturist
110650NCMDCertified Registered Nurse Anesthetist
151711VAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Professional Anesthesia Providers, PC Nurse Anesthetist, Certified Registered Past Accepting new patients
Surgery Center of Central Virginia Inc. Past Accepting new patients
Medical Anesthesia and Pain Management Consultants, P.a. Past Accepting new patients
LJP Anesthesia Services, PLLC Nurse Anesthetist, Certified Registered Past Accepting new patients

Organizations & group practices 6

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": "1117152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1249344000000",
    "number": "1790788396",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14489",
            "city": "ARCHDALE",
            "state": "NC",
            "postal_code": "272637489",
            "telephone_number": "800-277-8151",
            "fax_number": "336-841-6217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1834 GRAVES MILL RD",
            "city": "FOREST",
            "state": "VA",
            "postal_code": "24551",
            "telephone_number": "800-277-8151",
            "fax_number": "336-841-6217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LECATES",
        "first_name": "SAMUEL",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-27",
        "last_updated": "2009-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "110650",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "151711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010029601",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Forest, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2009; 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.