NPIMap

Organization Active NPI

Etherco Anesthesia PLLC

  • Certified Registered Nurse Anesthetist
  • Pine Bluff, AR
National Provider Identifier
1922838523
Registry record updated Aug 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
ETHERCO ANESTHESIA PLLC
Practice address
7005 S Hazel St
Pine Bluff, AR 71603-7833
Phone
(501) 227-7000
Fax
(501) 227-0744
NPI assigned
Aug 7, 2024
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 7, 2024

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

Authorized official

Name
Shamsie Lumpkin, CRNANPI 1346971009
Title
Partner
Phone
(501) 366-1907

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

7005 S Hazel St
Pine Bluff, AR 71603-7833

Mailing address

PO Box 55990
Little Rock, AR 72215-5990
Phone (501) 227-0700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240828001555 AR Part B Supplier - Clinic/Group Practice 2466991922 Receives reassigned benefits from 6 practitioners
Practice locations: Pine Bluff, AR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1722988800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722988800000",
    "number": "1922838523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 55990",
            "city": "LITTLE ROCK",
            "state": "AR",
            "postal_code": "722155990",
            "telephone_number": "501-227-0700",
            "fax_number": "501-227-0744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7005 S HAZEL ST",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716037833",
            "telephone_number": "501-227-7000",
            "fax_number": "501-227-0744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ETHERCO ANESTHESIA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-07",
        "last_updated": "2024-08-07",
        "certification_date": "2024-08-07",
        "status": "A",
        "authorized_official_last_name": "LUMPKIN",
        "authorized_official_first_name": "SHAMSIE",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "501-366-1907",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Bluff, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; 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.