Individual provider Active NPI

Avantika Cadambi, CRNA

  • Certified Registered Nurse Anesthetist
  • Keller, TX
National Provider Identifier
1811974009
Registry record updated Jul 31, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
051958 Issued in TX
Practice address
957 Monarch Way
Keller, TX 76248-5266
Phone
(817) 562-4879
NPI assigned
Dec 28, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 31, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 617986 TX
Certified Registered Nurse Anesthetist 367500000X 051958 TX Primary

Addresses

Primary practice location

957 Monarch Way
Keller, TX 76248-5266

Mailing address

PO Box 11219
Fort Worth, TX 76110-0219
Phone (817) 294-7444

Other identifiers 3

IdentifierTypeStateIssuer
0031031-09MedicaidTX
003103107MedicaidTX
8473UAOtherBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041016000134 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 3375503030 Reassigns benefits to 3 organizations
Practice locations: Nacogdoches, TX; Southlake, TX

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Afterglow Anesthesia PLLCGroup PAC ID 8022543370, 64 clinicians
Endo Sedation LLCGroup PAC ID 4789845363, 289 clinicians

Practice addresses (Care Compare)

1545 E Southlake Blvd
Southlake, TX 76092-6422
Phone (817) 748-8784

2704 N Galloway Ave
Suite 102
Mesquite, TX 75150-6379
Phone (972) 961-7171

2727 E Lemmon Ave
Dallas, TX 75204-2833
Phone (214) 443-3000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
51958TXMDPharmacist
051958TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Clearwater Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince May 1, 2008 Accepting new patients
Endo Sedation LLC Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2017 Accepting new patients
Endo Sedation LLC Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2017 Accepting new patients
Alliance Anesthesiology Associates, LP Nurse Anesthetist, Certified Registered Past Accepting new patients
Northstar Anesthesia, PA Nurse Anesthetist, Certified Registered Past Accepting new patients
Alliance Anesthesia Associates, PA Nurse Anesthetist, Certified Registered Past Accepting new patients
Sundance Anesthesia PA Past Accepting new patients
Sheridan Healthcare of North Texas PA Past Accepting new patients
Apex Anesthesia Consultants, PLLC Past Accepting new patients

Locations

3301 S 14th St
Ste 16180
Abilene, TX 79605

3107 W Camp Wisdom Rd
Ste 189
Dallas, TX 75237
Phone (214) 331-2922

1001 Surrey Ln
Flower Mound, TX 75022
Phone (817) 337-3671

6551 Harris Pkwy
Ste 100
Fort Worth, TX 76132
Phone (817) 346-3800

180 Bear Creek Pkwy
Keller, TX 76248
Phone (817) 337-3671

2704 N Galloway Ave
Ste 102
Mesquite, TX 75150
Phone (972) 961-7171

515 S Nolen Dr
Southlake, TX 76092
Phone (817) 912-1999

1980 E State Highway 114
Southlake, TX 76092
Phone (817) 329-2700

Organizations & group practices 10

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": "1135728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1343692800000",
    "number": "1811974009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 11219",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761100219",
            "telephone_number": "817-294-7444",
            "fax_number": "817-294-7172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "957 MONARCH WAY",
            "city": "KELLER",
            "state": "TX",
            "postal_code": "762485266",
            "telephone_number": "817-562-4879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CADAMBI",
        "first_name": "AVANTIKA",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-12-28",
        "last_updated": "2012-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TX",
            "license": "617986",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "051958",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0031031-09",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003103107",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8473UA",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Keller, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2012; 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.