Individual provider Active NPI

Gregory P Rendelman, CRNA

  • Certified Registered Nurse Anesthetist
  • Wichita Falls, TX
National Provider Identifier
1871508226
Registry record updated Oct 29, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
705261 Issued in TX
Practice address
1600 11TH St
Wichita Falls, TX 76301-4300
Phone
(940) 764-7000
NPI assigned
Jul 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 29, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 705261 TX Primary

Addresses

Primary practice location

1600 11TH St
Wichita Falls, TX 76301-4300

Mailing address

4217 Canyon Trails Dr
Wichita Falls, TX 76309-2705
Phone (940) 692-7085

Other identifiers 2

IdentifierTypeStateIssuer
169907601MedicaidTX
84703UOtherTXBCBSTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050518000094 PA Practitioner - Certified Registered Nurse Anesthetist (Crna) 8224013214 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1983
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rgal Anesthesia Services LLCGroup PAC ID 7517130602, 126 clinicians

Practice addresses (Care Compare)

2112 Harrisburg Pike
Suite 202
Lancaster, PA 17601-2644
Phone (717) 869-4600

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Rgal Anesthesia Services LLC CurrentSince Aug 1, 2021 Accepting new patients
Sda Consultants PLLC Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2021 Accepting new patients
Clinical Partners PA Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

400 10th St E
Waconia, MN 55387

2112 Harrisburg Pike
Ste 202
Lancaster, PA 17601
Phone (717) 544-3500

2104 Harrisburg Pike
Ste 300
Lancaster, PA 17601
Phone (717) 544-3400

1861 Powder Mill Rd
York, PA 17402
Phone (717) 718-2000

Organizations & group practices 3

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": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193616000000",
    "number": "1871508226",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4217 CANYON TRAILS DR",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763092705",
            "telephone_number": "940-692-7085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 11TH ST",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763014300",
            "telephone_number": "940-764-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RENDELMAN",
        "first_name": "GREGORY",
        "middle_name": "P",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2007-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "705261",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "169907601",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "84703U",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2007; 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.