Paul David Lystrup, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

636868 Issued in NY

Practice address

4900 Broad Rd
Syracuse, NY 13215-2265

Phone

(315) 492-5011

NPI assigned

Oct 24, 2010

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Premier Anesthesia of Richland a Division of Premier Anesthesia, LLCGroup PAC ID 4880699172, 88 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lourdes Medical Center Hospital, Pasco, WA, CCN 501337

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: plystrup4064794@wm.providencedirect.org

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.

• Premier Anesthesia of Richland a Division of Premier Anesthesia, LLC

  dba Premier Anesthesia of Richland

  • Anesthesiology Physician
  • Richland, WA
  • NPI 1013940253

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Tri-State Memorial Hospital

  • Critical Access Hospital
  • Clarkston, WA
  • NPI 1598814352
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Lourdes Hospital LLC

  dba Lourdes Medical Center

  • Critical Access Hospital
  • Pasco, WA
  • NPI 1831284280
  Care Compare affiliation

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

{
    "created_epoch": "1287878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1303776000000",
    "number": "1831499920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3418 HAMMOCKS DR",
            "address_2": "APT 308",
            "city": "BALDWINSVILLE",
            "state": "NY",
            "postal_code": "130274260",
            "telephone_number": "623-466-3387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4900 BROAD RD",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132152265",
            "telephone_number": "315-492-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LYSTRUP",
        "first_name": "PAUL",
        "middle_name": "DAVID",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-10-24",
        "last_updated": "2011-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "22 636868",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "636868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Annette Lyons, D.O.
• Jason Lyons
• Tania Marie Lyons, LMSW
• Terri E Lyons, PA
• Midzy B Lysius, NP
• Tammy Louise Lytle, PT
• Margaret Lyttle, LMSW
• M R Goriganti Physician PLLC
• M&a Mobilityllc
• M&M Industries LLC (A2Z Home Medical Supplies)

• Certified Registered Nurse Anesthetist in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Certified Registered Nurse Anesthetist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 2011; 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.