NPIMap

Organization Active NPI

Rogue Anesthesia LLC

  • Anesthesiology Physician
  • Grants Pass, OR
National Provider Identifier
1043248917
Registry record updated Nov 1, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
MD18872 Issued in OR
Legal business name
ROGUE ANESTHESIA LLC
Practice address
1601 NW Hawthorne Ave
Grants Pass, OR 97526
Phone
(541) 472-4884
NPI assigned
Jun 29, 2006
Last updated
Nov 1, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Robert A Montgomery III, MDNPI 1528008562
Title
Manager
Phone
(541) 472-4884

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X MD18872 OR Primary

Addresses

Primary practice location

1601 NW Hawthorne Ave
Grants Pass, OR 97526

Mailing address

5319 SW Westgate Dr
241
Portland, OR 97221-2432
Phone (503) 297-7223

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040816000274 OR Part B Supplier - Clinic/Group Practice 9830162197 Receives reassigned benefits from 8 practitioners
Practice locations: Grants Pass, OR; Talent, OR; Medford, OR; Ashland, OR

National Provider Directory

National Provider Directory
Tax ID family
Rogue Anesthesia LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

5319 SW Westgate Dr
Ste 241
Portland, OR 97221
Phone (503) 360-6656

Practitioners & affiliated clinicians

Practitioners 9

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1288569600000",
    "number": "1043248917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5319 SW WESTGATE DR",
            "address_2": "241",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972212432",
            "telephone_number": "503-297-7223",
            "fax_number": "503-297-7603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 NW HAWTHORNE AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "97526",
            "telephone_number": "541-472-4884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROGUE ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-29",
        "last_updated": "2010-11-01",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "541-472-4884",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "OR",
            "license": "MD18872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grants Pass, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.