Individual provider Active NPI

Alton Wayne Funderburk Jr., CRNA

  • Certified Registered Nurse Anesthetist
  • Amarillo, TX
National Provider Identifier
1891071643
Registry record updated Oct 25, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
678869 Issued in TX
Practice address
1600 Wallace Blvd
Amarillo, TX 79106-1799
Phone
(806) 212-5803
NPI assigned
Oct 25, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 25, 2011

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 678869 TX Primary

Addresses

Primary practice location

1600 Wallace Blvd
Amarillo, TX 79106-1799

Mailing address

11884 Moorhen Cir
Fort Worth, TX 76244-7587
Phone (214) 364-8028

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111209000034 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 5597930214 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Emergenchealth PLLCGroup PAC ID 1355606641, 1,037 clinicians

Practice addresses (Care Compare)

600 Elizabeth St
Christus Spohn Hospital Corpus Christi SH
Corpus Christi, TX 78404-2235
Phone (361) 881-3657

7400 Barlite Blvd
San Antonio, TX 78224-1308
Phone (210) 921-2000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Emergenchealth PLLC Nurse Anesthetist, Certified Registered CurrentSince Nov 15, 2018 Accepting new patients
Northstar Anesthesia II PA Nurse Anesthetist, Certified Registered CurrentSince Aug 28, 2018 Accepting new patients
Northstar Anesthesia, PA Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2014 Accepting new patients
Northstar Anesthesia III PA Nurse Anesthetist, Certified Registered CurrentSince Apr 9, 2021 Accepting new patients

Locations

2500 E Main St
Alice, TX 78332
Phone (361) 664-4376

108 Denver Trl
Azle, TX 76020
Phone (817) 444-8600

1500 E Houston St
Beeville, TX 78102
Phone (361) 354-2000

11801 South Fwy
Burleson, TX 76028
Phone (817) 551-2738

3315 S Alameda St
Corpus Christi, TX 78411
Phone (361) 761-1400

5950 Saratoga Blvd
Corpus Christi, TX 78414
Phone (321) 917-9263

7101 S Padre Island Dr
Corpus Christi, TX 78412
Phone (361) 761-1400

600 Elizabeth St
Corpus Christi, TX 78404
Phone (361) 325-2511

7777 Forest Ln
Dallas, TX 75230
Phone (972) 566-7283

909 9th Ave
Ft Worth, TX 76104
Phone (817) 336-6060

1917 Ashland St
Houston, TX 77008
Phone (713) 861-6161

1311 Gen Cvazos Blvd
Kingsville, TX 78363
Phone (361) 595-1661

500 W 4th St
Odessa, TX 79761
Phone (432) 640-1000

6200 W Parker Rd
Plano, TX 75093
Phone (972) 608-8000

401 W Campbell Rd
Richardson, TX 75080
Phone (940) 384-3535

7909 Fredericksburg Rd
San Antonio, TX 78229
Phone (210) 437-0884

7400 Barlite Blvd
San Antonio, TX 78224
Phone (210) 921-2000

1000 Pine St
Texarkana, TX 75501
Phone (903) 798-7365

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1319500800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319500800000",
    "number": "1891071643",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11884 MOORHEN CIR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "762447587",
            "telephone_number": "214-364-8028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 WALLACE BLVD",
            "city": "AMARILLO",
            "state": "TX",
            "postal_code": "791061799",
            "telephone_number": "806-212-5803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNDERBURK",
        "first_name": "ALTON",
        "middle_name": "WAYNE",
        "name_suffix": "Jr.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-10-25",
        "last_updated": "2011-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "678869",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Amarillo, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.