Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jacob David Sandefur, CRNA

Individual provider Registered Nurse · NPI 1770212417

Jacob David Sandefur, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in LA Grande, Oregon. Qualified in 2022, 4 years ago. Practices with Evergreen Anesthesia Associates LLC, a 26-clinician group and accepts Medicare assignment. Licensed in Oregon and Tennessee.

Years since qualifying
4
Licensed in
OR, TN
In the registry since
2022
Specialties on file
2
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

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Practice location Address checks out

900 Sunset Dr
LA Grande, OR 97850-1387
Phone: (541) 963-8421
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 202214569CRNAPP (OR)
Registered Nurse Taxonomy 163W00000X · Licence 239503 (TN)

Record details

NPI number1770212417
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNA
Sole proprietorYes
NPI enumeratedJune 8, 2022
Last updated in NPPESSeptember 23, 2022
Certification dateJuly 12, 2022

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Evergreen Anesthesia Associates Llc — 26 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations3 on file with Medicare

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