Individual provider Active NPI

Christiana J Ankiambom, CRNA

  • Certified Registered Nurse Anesthetist
  • Bristol, CT
National Provider Identifier
1891785762
Registry record updated Feb 17, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
005978 Issued in CT
Practice address
41 Brewster Rd
Bristol, CT 06010-5141
Phone
(860) 585-3474
NPI assigned
Oct 24, 2005
Last updated
Feb 17, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 17, 2015

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 005978 CT Primary
Certified Registered Nurse Anesthetist 367500000X 07924 OH
Registered Nurse 163W00000X 122652 CT
Registered Nurse 163W00000X 362351 NY
Registered Nurse 163W00000X 314823 OH

Addresses

Primary practice location

41 Brewster Rd
Bristol, CT 06010-5141

Mailing address

PO Box 417297
Boston, MA 02241-7297
Phone (866) 623-3869

Other identifiers 2

IdentifierTypeStateIssuer
53698OtherAANA
2539604MedicaidOH

Other names 1

  • Christiana Juliana Carter Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150320000218 CT Practitioner - Certified Registered Nurse Anesthetist (Crna) 8022082320 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
122652CTMDRegistered Nurse
362351NYMDRegistered Nurse
314823OHMDRegistered Nurse
005978CTMDMassage Therapist
07924OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Integrated Anesthesia Associates LLC Nurse Anesthetist, Certified Registered CurrentSince May 1, 2018 Accepting new patients
Perioperative Medical Consutants Inc Past Accepting new patients
Outpatient Anesthesia Specialists PastSince Jan 1, 2008 Accepting new patients

Locations

80 Seymour St
Hartford, CT 06106
Phone (860) 545-2249

300 Seaside Ave
Milford, CT 06460
Phone (203) 876-4000

2 Corporate Dr
Ste 955
Shelton, CT 06484
Phone (203) 929-7375

2 Trap Falls Rd
Ste 414
Shelton, CT 06484
Phone (203) 282-4128

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424131200000",
    "number": "1891785762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 417297",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022417297",
            "telephone_number": "866-623-3869",
            "fax_number": "302-733-0854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "41 BREWSTER RD",
            "city": "BRISTOL",
            "state": "CT",
            "postal_code": "060105141",
            "telephone_number": "860-585-3474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANKIAMBOM",
        "first_name": "CHRISTIANA",
        "middle_name": "J",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-24",
        "last_updated": "2015-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "CT",
            "license": "005978",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "07924",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CT",
            "license": "122652",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NY",
            "license": "362351",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "314823",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AANA",
            "identifier": "53698",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2539604",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHRISTIANA",
            "last_name": "CARTER",
            "middle_name": "JULIANA",
            "credential": "RN, CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Bristol, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2015; 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.