Charlie S. Blalock, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

668515 Issued in TX

Practice address

4916 Overton PLZ
Fort Worth, TX 76109-4415

Phone

(800) 480-1819

Fax

(817) 334-0235

NPI assigned

Feb 1, 2007

Last updated

Feb 5, 2009By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TX, CO2 enrollments

Enrollment records 2

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northstar Anesthesia III PAGroup PAC ID 0042630501, 393 clinicians

Emergenchealth PLLCGroup PAC ID 1355606641, 1,037 clinicians

Animas Anesthesia Associates LLCGroup PAC ID 2668668997, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ut Health East Texas Tyler Regional Hospital Hospital, Tyler, TX, CCN 450083

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Emergenchealth PLLC

  • Anesthesiology Physician
  • Fort Worth, TX
  • NPI 1467970897

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Northstar Anesthesia III PA

  • Anesthesiology Physician
  • Corpus Christi, TX
  • NPI 1356968952

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Animas Anesthesia Associates LLC

  • Anesthesiology Physician
  • Durango, CO
  • NPI 1104148642
  Medicare reassignment Care Compare group
• Mother Frances Hospital Regional Health Care Center

  dba Christus Mother Frances Hospital Tyler

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1679578439
  Medicare reassignment NPD
• Amarillo Anesthesia Consultants PA

  • Anesthesiology Physician
  • Fort Worth, TX
  • NPI 1326196288

  Nurse Anesthetist, Certified Registered

  NPD (past)

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

• Tyler Regional Hospital LLC

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1407364847
  Care Compare affiliation

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

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233792000000",
    "number": "1861530156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50667",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791590667",
            "telephone_number": "800-480-1819",
            "fax_number": "817-334-0235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4916 OVERTON PLZ",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094415",
            "telephone_number": "800-480-1819",
            "fax_number": "817-334-0235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLALOCK",
        "first_name": "CHARLIE",
        "middle_name": "S.",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2009-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "668515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Christina Blake, MD
• Abby L Blakely, LCSW
• Margaret Lipham Blakely, MED, LPC
• Michelle Dawn Blakeman, LCSW
• Allison Blakewell, RN
• Jake Blalock, MD
• Katherine Lindsey Blalock, ACNP
• Ashley Blanch, PHARMD
• Michelle Blanchard, FNP-BC
• Sonji M Blanchard

• Certified Registered Nurse Anesthetist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Certified Registered Nurse Anesthetist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 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.