NPI Record of COMFORT CARE ANESTHESIA LLC NPI 1003031121

Nurse Anesthetist, Certified Registered in Laurel, MD

Complete NPI Record

Field Name Value Definition
NPI1003031121The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameCOMFORT CARE ANESTHESIA LLCThe name of the organization provider. If the provider is an organization, this is the legal business name.
Provider First Line Business Mailing Address10512 TWIN CEDAR CTThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameLAURELThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameMDThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code207235721The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number3014979944The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address10512 TWIN CEDAR CTThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameLAURELThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameMDThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code207235721The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number3014979944The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date4/16/2007The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date4/1/2008The date that a record was last updated or changed.
Authorized Official Last NameFLEMINGThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameTAWYANAThe first name of the authorized official.
Authorized Official Middle NameMAEThe middle name of the authorized official.
Authorized Official Title or PositionCRNAThe title or position of the authorized official.
Authorized Official Telephone Number3014979944The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1367500000XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 135280The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1WVThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1N
Healthcare Provider Taxonomy Code 2367500000X
Provider License Number 2180984The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 2NCThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 2N
Healthcare Provider Taxonomy Code 3367500000X
Provider License Number 31499The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 3SCThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 3N
Healthcare Provider Taxonomy Code 4367500000X
Provider License Number 4R143442The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 4MDThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 4Y
Other Provider Identifier 1469PAdditional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 101Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 1MD
Other Provider Identifier Issuer 1MEDICARE
Other Provider Identifier 2DG3055Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 201Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 2GA
Other Provider Identifier Issuer 2RAILROAD MEDICARE
Other Provider Identifier 347TCTMAdditional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
Other Provider Identifier Type Code 301Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
Other Provider Identifier State 3MD
Other Provider Identifier Issuer 3CAREFIRST
Is Organization SubpartN
Authorized Official Name Prefix TextMRS.
Authorized Official Credential TextCRNA
Healthcare Provider Taxonomy Group 1193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 2193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 3193200000X MULTI-SPECIALTY GROUP
Healthcare Provider Taxonomy Group 4193200000X MULTI-SPECIALTY GROUP