John Bollenbacher, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

086417 Issued in MO

Practice address

219 Physicians Park
Poplar Bluff, MO 63901-3956

Phone

(573) 686-5550

NPI assigned

Jan 11, 2006

Last updated

Apr 4, 2008By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Poplar Bluff Regional Medical Center LLC

  dba Poplar Bluff Regional Medical Center

  • General Acute Care Hospital
  • Poplar Bluff, MO
  • NPI 1700831724

  Nurse Anesthetist, Certified Registered

  NPD (past)

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

{
    "created_epoch": "1136937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207267200000",
    "number": "1952380792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2140 AUTUMN RD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639012703",
            "telephone_number": "573-686-5550",
            "fax_number": "573-686-2139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "219 PHYSICIANS PARK",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013956",
            "telephone_number": "573-686-5550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOLLENBACHER",
        "first_name": "JOHN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-11",
        "last_updated": "2008-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "086417",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "184883",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00100713",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bluff Prosthetics and Orthotics LLC (SEMO Prosthetics & Orthotics)
• Bluff Radiology Group, LLC
• Joseph David Blume
• Deborah Elaine Boles
• Chelsea Bolin, LCSW
• Wendy N Boone
• Timberlee Lynne Booth
• Carl Eugene Bosley, D.O.
• Roger Kingsley Bost, MD
• Kyle Demetri Bounds

• Certified Registered Nurse Anesthetist in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Certified Registered Nurse Anesthetist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.