SHANE RICHARD SMITH (CRNA) – Certified Registered Nurse Anesthetist, NPI 1063137677

SHANE RICHARD SMITH (CRNA) is a healthcare provider. based in Sugar city, Idaho. specializing in CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA). They hold the professional credentials CRNA. They hold a License No. 145179 (AK). The NPI Number for SHANE RICHARD SMITH (CRNA) is 1063137677

Main info

Male
Sole Proprietor
4 Years Of Experience
Accepts Medicare Assignment
Name
SHANE RICHARD SMITH (CRNA)
NPI
1063137677
Phone
(360) 600-7852
Address
2 N 3000 E
Enumeration Date
5 October 2022
Last Update Date
5 October 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9074593500
Graduation Year
2022 (4 years ago)
PAC ID
3870962574
Group Practice PAC ID
5698056901
Professional Enrollment ID
I20221219001645
Address ID
AK997015907FA1650XSTXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience30
Completeness75
Years active:3State licenses:1Digital endpointsOther names

133 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in AK

Provider Addresses for SHANE RICHARD SMITH (CRNA)

  • 2 N 3000 E

    SUGAR CITY, ID 834481220

    Phone: (360) 600-7852

    Type: Mailing

  • 1650 COWLES ST

    FAIRBANKS, AK 997015907

    Phone: (907) 452-8181

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2022-12-19

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20221219001645ICertified Registered Nurse Anesthetist (Crna)AKTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
00142Anesthesia for lens surgery4641$0
00811Anesthesia for other procedure on large bowel using an endoscope1616$0
View full utilization report →

Insurance plans in this area (ZIP 83448)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 5698056901View full group profile
NameSpecialtyState
Certified Registered Nurse Anesthetist (Crna)LA
Certified Registered Nurse Anesthetist (Crna)AK
A N E S T H E S I O L O G YMD
P S Y C H I A T R YWA
H O S P I T A L I S TCA
Emergency MedicineAK
U R O L O G YAK
Family PracticeAK
-AK
P S Y C H I A T R YHI

Reviews

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Frequently asked questions

What number should I use to identify SHANE RICHARD SMITH (CRNA) for billing?
Administrative and clinical systems typically use NPI 1063137677 for SHANE RICHARD SMITH (CRNA).
Does the public listing show SHANE RICHARD SMITH (CRNA) as active?
SHANE RICHARD SMITH (CRNA)'s NPI record reflects an active status in NPPES.
What services align with SHANE RICHARD SMITH (CRNA)'s listing?
SHANE RICHARD SMITH (CRNA)'s public classification highlights Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.
Is SHANE RICHARD SMITH (CRNA) tied to Sugar City, Idaho?
If you are local to Sugar City, Idaho, SHANE RICHARD SMITH (CRNA) may be relevant to your search.
Can I export SHANE RICHARD SMITH (CRNA)'s record?
You can download the official NPPES record; we summarize key fields for readability.

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