Individual provider Active NPI

Scott K Shaffer

  • Certified Registered Nurse Anesthetist
  • Salida, CO
National Provider Identifier
1881626562
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
165807 Issued in CO
Practice address
448 E 1St St
Salida, CO 81201-2804
Phone
(719) 539-6661
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 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 165807 CO Primary

Addresses

Primary practice location

448 E 1St St
Salida, CO 81201-2804

Mailing address

3863 SW Loop 820
Suite 300
Fort Worth, TX 76133-2064
Phone (877) 294-7444

Other identifiers 1

IdentifierTypeStateIssuer
59338547MedicaidCO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041116000556 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 6608848320 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
165807COMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Stratus Dominion Anesthesia Associates PLLC Nurse Anesthetist, Certified Registered CurrentSince May 25, 2024 Accepting new patients
Hill Regional Physician Group, Inc. Nurse Anesthetist, Certified Registered CurrentSince May 25, 2024 Accepting new patients
Stratus Anesthesia Associates Dallas PLLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Stratus Anesthesia Associates Southlake PLLC Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

5600 W Lovers Ln
Dallas, TX 75209
Phone (214) 520-4000

25 Highland Park Vlg
Ste 100765
Dallas, TX 75205
Phone (214) 219-3747

3455 Locke Ave
Ste 210
Fort Worth, TX 76107
Phone (817) 377-5223

101 Circle Dr
Hillsboro, TX 76645
Phone (254) 580-8500

2600 W Pleasant Run Rd
Lancaster, TX 75146
Phone (469) 297-5321

1324 Brown St
Waxahachie, TX 75165
Phone (972) 937-4000

Organizations & group practices 4

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": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1881626562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3863 SW LOOP 820",
            "address_2": "SUITE 300",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761332064",
            "telephone_number": "877-294-7444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "448 E 1ST ST",
            "city": "SALIDA",
            "state": "CO",
            "postal_code": "812012804",
            "telephone_number": "719-539-6661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "SCOTT",
        "middle_name": "K",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CO",
            "license": "165807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "59338547",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salida, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.