Individual provider Active NPI

Chance Green, CRNA

  • Certified Registered Nurse Anesthetist
  • Lakeside, AZ
National Provider Identifier
1962448480
Registry record updated Mar 19, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
28162181 Issued in IN
Practice address
5448 Highway 260 Ste 100
Lakeside, AZ 85929-5736
Phone
(928) 359-1862
Fax
(928) 537-2049
NPI assigned
Jun 22, 2006
Last updated
Mar 19, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 19, 2026

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 28162181 IN Primary

Addresses

Primary practice location

5448 Highway 260 Ste 100
Lakeside, AZ 85929-5736

Mailing address

135 N Center St Unit 5870
Mesa, AZ 85211-7159
Phone (480) 874-7014

Other practice location 1

200 W Hospital Dr
Whiteriver, AZ 85941-0860
Phone (928) 338-4911

Other identifiers 1

IdentifierTypeStateIssuer
200513510MedicaidIN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090311000708 AZ Practitioner - Certified Registered Nurse Anesthetist (Crna) 1850341900 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

5448 S White Mountain Blvd
Suite 100
Lakeside, AZ 85929-5739
Phone (928) 532-3010

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fancy Anesthesia Services Inc Nurse Anesthetist, Certified Registered CurrentSince Feb 23, 2009 Accepting new patients
Northeastern Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2011 Accepting new patients
Cardinal Anesthesia, PLLC Nurse Anesthetist, Certified Registered CurrentSince Oct 17, 2024 Accepting new patients
Antigua Anesthesia Management, LLC CurrentSince Mar 17, 2026 Accepting new patients
MB Anesthesiology LLC Nurse Anesthetist, Certified Registered PastSince May 4, 2025 Accepting new patients
Northern Indiana Anesthesia Services, P.C. Nurse Anesthetist, Certified Registered Past Accepting new patients
Anesthesia Associates of Savannah ,PA Past Accepting new patients

Locations

5448 Highway 260
Ste 100
Lakeside, AZ 85929
Phone (283) 581-8629

2200 E Show Low Lake Rd
Show Low, AZ 85901
Phone (928) 537-4375

Organizations & group practices 7

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": "1150934400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773878400000",
    "number": "1962448480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "135 N CENTER ST UNIT 5870",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852117159",
            "telephone_number": "480-874-7014",
            "fax_number": "480-874-7015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5448 HIGHWAY 260 STE 100",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859295736",
            "telephone_number": "928-359-1862",
            "fax_number": "928-537-2049"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 W HOSPITAL DR",
            "address_purpose": "LOCATION",
            "city": "WHITERIVER",
            "state": "AZ",
            "postal_code": "859410860",
            "country_code": "US",
            "telephone_number": "928-338-4911",
            "fax_number": "928-338-3522",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GREEN",
        "first_name": "CHANCE",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-22",
        "last_updated": "2026-03-19",
        "certification_date": "2026-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "28162181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200513510",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakeside, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2026; 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.