Active NPI
Mark A Tiede, CRNA
- Certified Registered Nurse Anesthetist
- Phoenix, AZ
National Provider Identifier
1962486076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- RN077787
- Practice address
- 5777 E Mayo Blvd
Phoenix, AZ 85054-4502 - Phone
- (480) 301-8000
- NPI assigned
- Dec 1, 2005
- 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 | RN077787 | AZ | Primary |
Addresses
Primary practice location
5777 E Mayo Blvd
Phoenix, AZ 85054-4502
Mailing address
5777 E Mayo Blvd
Phoenix, AZ 85054-4502
Phone (480) 301-8000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 467961 | Medicaid | AZ |
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 |
|---|---|---|---|
| RN077787 | AZ | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1133395200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1193788800000",
"number": "1962486076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5777 E MAYO BLVD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850544502",
"telephone_number": "480-301-8000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5777 E MAYO BLVD",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850544502",
"telephone_number": "480-301-8000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIEDE",
"first_name": "MARK",
"middle_name": "A",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-01",
"last_updated": "2007-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "AZ",
"license": "RN077787",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "467961",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.