Active NPI
Theodore Eckert III, CRNA
- Certified Registered Nurse Anesthetist
- Fairfax, VA
National Provider Identifier
1891880670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 0024165695
- Practice address
- 3600 Joseph Siewick Dr
#202
Fairfax, VA 22033-1709 - Phone
- (703) 922-9501
- Fax
- (703) 295-9369
- NPI assigned
- Oct 4, 2006
- Last updated
- Apr 28, 2015
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 0024165695 | VA | Primary |
Addresses
Primary practice location
3600 Joseph Siewick Dr
#202
Fairfax, VA 22033-1709
Mailing address
3998 Fair Ridge Dr
Suite 300
Fairfax, VA 22033-2921
Phone (703) 295-9360
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 139180 | Other | VA | ANTHEM |
| K142-0002 | Other | DC | CAREFIRST |
| 297579 | Other | VA | AMERIGROUP |
| 1891880670 | Medicaid | VA | |
| 562605 | Other | VA | NCPPO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0024165695 | VA | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1430179200000",
"number": "1891880670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3998 FAIR RIDGE DR",
"address_2": "SUITE 300",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220332921",
"telephone_number": "703-295-9360",
"fax_number": "703-766-9725"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3600 JOSEPH SIEWICK DR",
"address_2": "#202",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220331709",
"telephone_number": "703-922-9501",
"fax_number": "703-295-9369"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ECKERT",
"first_name": "THEODORE",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-04",
"last_updated": "2015-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "VA",
"license": "0024165695",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "139180",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAREFIRST",
"identifier": "K142-0002",
"state": "DC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIGROUP",
"identifier": "297579",
"state": "VA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1891880670",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NCPPO",
"identifier": "562605",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.