Individual provider Active NPI

Brian Bao Le, CRNA

  • Certified Registered Nurse Anesthetist
  • Bangor, ME
National Provider Identifier
1982718615
Registry record updated Jan 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
51629 Issued in ME
Practice address
489 State St
Bangor, ME 04401-6616
Phone
(207) 973-4519
Fax
(207) 992-4132
NPI assigned
Aug 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 3, 2022

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 51629 ME Primary

Addresses

Primary practice location

489 State St
Bangor, ME 04401-6616

Mailing address

51 Harborside Rd
Harborside, ME 04642-3003
Phone (207) 992-4032

Other identifiers 1

IdentifierTypeStateIssuer
ME183803OtherMEMEDICARE P-TAN FOR BHMH

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150127001788 CA Practitioner - Certified Registered Nurse Anesthetist (Crna) 6406862655 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

2425 Geary Blvd
San Francisco, CA 94115-3358
Phone (415) 833-2200

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4137CAMDAudiologist-Hearing Aid Fitter
51629MEMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Cec, LLC CurrentSince Mar 31, 2016 Accepting new patients
Permanente Medical Group Inc CurrentSince Dec 10, 2016 Accepting new patients
Permanente Medical Group, Inc CurrentSince Dec 10, 2016 Accepting new patients
Mai Nursing Anesthesia PC CurrentSince Apr 9, 2022 Accepting new patients
Permanente Medical Group Inc Current Accepting new patients
Blue Eagle Anesthesia Inc a Professional Corporation CurrentSince Nov 1, 2021 Accepting new patients
Coastal Eye Surgery Center, LLC Past Accepting new patients

Locations

750 Auburn Ravine Rd
Auburn, CA 95603
Phone (530) 823-6131

429 Llewellyn Ave
Campbell, CA 95008
Phone (408) 358-5000

4753 W Shaw Ave
Ste 101
Fresno, CA 93722
Phone (559) 277-8738

900 N Douty St
Hanford, CA 93230
Phone (559) 587-9014

101 Monroe St
Petaluma, CA 94954
Phone (707) 763-4109

1700 San Pablo Ave
Ste D
Pinole, CA 94564
Phone (510) 724-9500

1150 Veterans Blvd
Redwood City, CA 94063
Phone (650) 299-2015

901 Nevin Ave
Richmond, CA 94801
Phone (510) 307-1500

930 W Main St
Ripon, CA 95366
Phone (209) 599-4221

3555 Cesar Chavez
San Francisco, CA 94110
Phone (415) 485-8824

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

2425 Geary Blvd
San Francisco, CA 94115
Phone (415) 833-2200

1160 Post St
San Francisco, CA 94109
Phone (415) 440-1100

710 Lawrence Expy
Santa Clara, CA 95051
Phone (408) 236-6400

3003 Paul Sweet Rd
Santa Cruz, CA 95065
Phone (831) 462-1607

3540 Mendocino Ave
Ste 200
Santa Rosa, CA 95403
Phone (707) 522-6200

7373 West Ln
Stockton, CA 95210
Phone (209) 476-2000

2160 W Grant Line Rd
Ste 120
Tracy, CA 95377
Phone (209) 832-2095

975 Sereno Dr
Vallejo, CA 94589
Phone (707) 651-1000

320 N Crawford St
Willows, CA 95988
Phone (530) 934-2834

128 Bucksport Rd
#B
Ellsworth, ME 04605
Phone (207) 667-6300

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 and National Provider Directory roles.

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": "1155945600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1982718615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "51 HARBORSIDE RD",
            "city": "HARBORSIDE",
            "state": "ME",
            "postal_code": "046423003",
            "telephone_number": "207-992-4032",
            "fax_number": "207-992-4034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 STATE ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016616",
            "telephone_number": "207-973-4519",
            "fax_number": "207-992-4132"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LE",
        "first_name": "BRIAN",
        "middle_name": "BAO",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-19",
        "last_updated": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ME",
            "license": "51629",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE P-TAN FOR BHMH",
            "identifier": "ME183803",
            "state": "ME"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "2425 Geary Blvd",
            "city": "San Francisco",
            "state": "CA",
            "country_code": "US",
            "postal_code": "941153358",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Bangor, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; 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.