Richard Gary Watts, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Mapleton, UT
NPI 1023113545 · NPPES record last updated Apr 29, 2024
Key facts
- NPI
- 1023113545
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 308580-4406 (UT)
- Practice address
- 151 E 1600 S
Mapleton, UT 84664-5202 - Phone
- (801) 491-6315
- Fax
- (801) 465-7122
- NPI assigned
- Sep 13, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Mountain View Anesthesia LC
Practice addresses (Care Compare)
96 E Kimballs LN
Suite 100
Draper, UT 84020-5002
Phone (801) 233-9300
Hospital & facility affiliations
- Timpanogos Regional Hospital
- Mountain View Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (3 enrollments) in UT, MT, ID
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050720001133 | UT | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 4789611732 | Reassigns benefits to 1 organization |
| I20120201000800 | MT | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 4789611732 | Reassigns benefits to 1 organization |
| I20150408002553 | ID | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 4789611732 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 308580-4406 | UT | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Benewah Community Hospital | Current |
Accepting new patients | |
| Benewah Community Hospital | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Butte Pain and Anesthesia Associates, PLLC | Current |
Accepting new patients | |
| Mountain View Anesthesia LC | Current |
Accepting new patients |
Locations
229 S 7th St
St Maries, ID 83861
Phone (208) 245-2591
400 S Clark St
Butte, MT 59701
Phone (406) 495-7260
96 E Kimballs Ln
Ste 100
Draper, UT 84020
Phone (801) 233-9300
1954 E Fort Union Blvd
Ste 105
Salt Lake Cty, UT 84121
Phone (801) 993-9524
Interoperability endpoints
- https://fhir-myrecord.cerner.com/r4/e8b4f872-6ea1-4b26-a974-041b5fb4c57b/
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | CRNA000370 | NV | |
| Certified Registered Nurse Anesthetist | 367500000X | RNA-846A | ID | |
| Certified Registered Nurse Anesthetist | 367500000X | 308580-4406 | UT | Yes |
Addresses
Primary practice location
151 E 1600 S
Mapleton, UT 84664-5202
Mailing address
151 E 1600 S
Mapleton, UT 84664-5202
Phone (801) 491-6315
Other practice location 1
229 S 7th St
St Maries, ID 83861-1803
Phone (208) 245-5551
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2246747 | Medicaid | WA | |
| D4599 | Medicaid | UT | |
| 1023113545 | Medicaid | ID |
Other providers in Mapleton, UT
- Wendy Sue Turnbow
- Breanna F Upstill
- Utah Mental Health Advocates LLC
- Mary Jill Wall
- Kyle Ward
- Tanya Preston Westmoreland
- Monica Amy Wilkinson
- Tricia Whitaker Winder
- Troy Marie Young
- Malinda Zonts
All providers in Mapleton, UT · Certified Registered Nurse Anesthetist in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.