Individual provider Active NPI

Matthew W. Adkins, CRNA

  • Certified Registered Nurse Anesthetist
  • Tyler, TX
National Provider Identifier
1942517008
Registry record updated Sep 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN120025 Issued in LA
Practice address
1000 S Beckham Ave
Department of Anesthesia
Tyler, TX 75701-1908
Phone
(888) 273-2498
Fax
(817) 877-0350
NPI assigned
Sep 9, 2010
Last updated
Sep 9, 2010By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 9, 2010

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 RN120025 LA Primary

Addresses

Primary practice location

1000 S Beckham Ave
Department of Anesthesia
Tyler, TX 75701-1908

Mailing address

PO Box 8027
Tyler, TX 75711-8027
Phone (817) 334-0530

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101220000550 LA Practitioner - Certified Registered Nurse Anesthetist (Crna) 0446448369 Reassigns benefits to 2 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
Homer Memorial HospitalGroup PAC ID 1456322692, 22 clinicians

Practice addresses (Care Compare)

620 E College St
Homer, LA 71040-3202
Phone (318) 927-2024

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN120025LAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Homer Memorial Hospital CurrentSince Sep 15, 2018 Accepting new patients
Tandem Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince Feb 26, 2013 Accepting new patients
Homer Memorial Hospital Nurse Anesthetist, Certified Registered CurrentSince Sep 15, 2018 Accepting new patients
East Texas Medical Center Nurse Anesthetist, Certified Registered Past Accepting new patients
Laser & Cataract Center of Shreveport LLC Past Accepting new patients

Locations

620 E College St
Homer, LA 71040
Phone (318) 927-2024

207 Jefferson St
Mansfield, LA 71052
Phone (318) 871-3109

445 Ashley Ridge Blvd
Shreveport, LA 71106
Phone (318) 869-1130

Organizations & group practices 5

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.

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": "1283990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283990400000",
    "number": "1942517008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8027",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757118027",
            "telephone_number": "817-334-0530",
            "fax_number": "817-877-0350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 S BECKHAM AVE",
            "address_2": "DEPARTMENT OF ANESTHESIA",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011908",
            "telephone_number": "888-273-2498",
            "fax_number": "817-877-0350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADKINS",
        "first_name": "MATTHEW",
        "middle_name": "W.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-09-09",
        "last_updated": "2010-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "LA",
            "license": "RN120025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2010; 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.