Active NPI
Robert Profeta, C.R.N.A.
- Certified Registered Nurse Anesthetist
- Spring, TX
National Provider Identifier
1821086950
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 687417
- Practice address
- 17207 Kuykendahl Rd
Suite 200
Spring, TX 77379-8423 - Phone
- (832) 698-5320
- NPI assigned
- Oct 12, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 687417 | TX | Primary |
Addresses
Primary practice location
17207 Kuykendahl Rd
Suite 200
Spring, TX 77379-8423
Mailing address
17207 Kuykendahl Rd
Suite 200
Spring, TX 77379-8423
Phone (832) 698-5320
Other practice location 1
575 Hill Country Dr Ste 101
Kerrville, TX 78028-6024
Phone (830) 258-7828
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 687417 | TX | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Long Island Anesthesia Physicians LLP | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Anesthesiology Physician
- Rocky Point, NY
- NPI 1952387276
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1681948800000",
"number": "1821086950",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17207 KUYKENDAHL RD",
"address_2": "SUITE 200",
"city": "SPRING",
"state": "TX",
"postal_code": "773798423",
"telephone_number": "832-698-5320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17207 KUYKENDAHL RD",
"address_2": "SUITE 200",
"city": "SPRING",
"state": "TX",
"postal_code": "773798423",
"telephone_number": "832-698-5320"
}
],
"practiceLocations": [
{
"address_1": "575 Hill Country Dr Ste 101",
"address_purpose": "LOCATION",
"city": "Kerrville",
"state": "TX",
"postal_code": "780286024",
"country_code": "US",
"telephone_number": "830-258-7828",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PROFETA",
"first_name": "ROBERT",
"name_prefix": "Mr.",
"credential": "C.R.N.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-12",
"last_updated": "2023-04-20",
"certification_date": "2023-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "TX",
"license": "687417",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Spring, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.