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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

CODY CROCKETT
NPI 1306523840
Nurse Anesthetist, Certified Registered in Portland, OR

Active since June 28, 2023
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239(503) 494-7641(503) 494-4661 Get Directions Write a Review

NPPES record last updated: September 22, 2026. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Cody Crockett NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

CODY CROCKETT (NPI 1306523840) is an individual nurse anesthetist, certified registered in Portland, Oregon, licensed in Oregon (10064069) and active in the NPI registry since June 2023. He maintains a secondary practice location in Portland and is a graduate of Oregon Health Sciences University School Of Medicine (2026).

NPPES Registry Identity

NPI1306523840
Entity TypeIndividualMale
Primary Taxonomy367500000X
Provider Legal NameCODY CROCKETT
Location Address3181 SW SAM JACKSON PARK RDPortland, OR 97239-3011
Mailing Address1400 Sw 5th Ave Ste 500Portland, OR 97201-5537 · Fax (503) 346-8021
Phone(503) 494-7641
Fax(503) 494-4661
Sole ProprietorNo
Medical School CMSOregon Health Sciences University School Of MedicineGraduated 2026
Enumeration DateJune 28, 2023
Last NPPES UpdateSeptember 22, 2026
NPPES CertifiedSeptember 22, 2026
✔ NPI 1306523840 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code367500000X
License✔ Licensed in OR · 10064069
Definition
(1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition.
3181 SW SAM JACKSON PARK RD, Portland, OR 97239
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Secondary Practice Location 1

Location 13455 SW US Veterans Hospital RdPortland, OR 97239-3076 · Phone (503) 494-7725

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Cody Crockett is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID6103385448
PECOS Enrollment IDI20260826004749

Medicare Billing Reassignment

Medicare enrollment records show Cody Crockett reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

University Anesthesiology Associates, LLC
Anesthesiology
3181 SW SAM JACKSON PARK RD, MAILCODE: SJH-2
Portland, OR 97239
  • Reassigned Medicare billing, Oregon enrollment
  • 279 clinicians in this Medicare group
NPI 1841217817 (503) 494-4910

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DONALD RICHARD SULLIVAN MD
Internal Medicine (Pulmonary Disease)
3181 SW SAM JACKSON PARK RD, UHN67
PORTLAND, OR 97239
Multnomah County (503) 494-6949
MRS. ANJALEE NIX ROWE NP
Nurse Practitioner (Acute Care)
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 494-3988
REEM HASAN MD
Internal Medicine
3181 SW SAM JACKSON PARK RD, PPV 350
PORTLAND, OR 97239
Multnomah County (503) 494-8562
DR. AMANDA D BALL PSY.D
Psychologist (Clinical)
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 494-6176
SUNSHINE WELSCH LMT
Massage Therapist
3181 SW SAM JACKSON PARK RD, 7D19
PORTLAND, OR 97239
Multnomah County (503) 494-8349
DR. ROBERT GENE MEALER M.D., PH.D.
Psychiatry & Neurology (Psychiatry)
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 494-6176
GREGORY HALL MD
Radiology (Diagnostic Radiology)
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 418-0990
DR. BURHAN AHMED MIAN MD
Student in an Organized Health Care Education/Training Program
3181 SW SAM JACKSON PARK RD
PORTLAND, OR 97239
Multnomah County (503) 494-8311

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Cody Crockett's NPI number?

The NPI number for Cody Crockett is 1306523840. It was assigned to this individual provider in the NPPES registry on June 28, 2023.

Where is Cody Crockett located?

Cody Crockett practices at 3181 SW Sam Jackson Park Rd, Portland, OR 97239. The listed phone number is (503) 494-7641.

What is Cody Crockett's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Is Cody Crockett enrolled in Medicare?

Yes. Cody Crockett is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Cody Crockett's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Cody Crockett reassigns Medicare benefits to University Anesthesiology Associates, LLC (Portland, OR). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Cody Crockett's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Cody Crockett was last updated on September 22, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 39 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.