Active NPI
Rogue Anesthesia LLC
- Anesthesiology Physician
- Grants Pass, OR
National Provider Identifier
1043248917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- MD18872
- 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
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Robert A Montgomery III, MD
- Title
- Manager
- Phone
- (541) 472-4884
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 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
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 130351 | Medicaid | OR | |
| 023807000 | Other | OR | REGENCE BCBSO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in OR
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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 LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Ambulatory Surgical Clinic/Center
- Grants Pass, OR
- NPI 1396040598
Practitioners & affiliated clinicians
Practitioners 8
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Certified Registered Nurse Anesthetist
- Grants Pass, OR
- NPI 1073590733
OR
-
- Certified Registered Nurse Anesthetist
- Grants Pass, OR
- NPI 1558922088
OR
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": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "130351",
"state": "OR"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "REGENCE BCBSO",
"identifier": "023807000",
"state": "OR"
}
],
"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.