NPIMap

Individual provider Active NPI

Matthew Fortier, CRNA

  • Certified Registered Nurse Anesthetist
  • Louisville, KY
National Provider Identifier
1104282805
Registry record updated Jan 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3010010 Issued in KY
Practice address
1 Audubon Plaza Dr
Louisville, KY 40217-1318
Phone
(502) 636-7160
NPI assigned
Jan 11, 2016
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 11, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 3010010 KY Primary

Addresses

Primary practice location

1 Audubon Plaza Dr
Louisville, KY 40217-1318

Mailing address

425 Lewis Hargett Cir
Lexington, KY 40503-3590
Phone (859) 268-1030

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160302002709 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 7315243268 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesiology Consultants Enterprises PLLCGroup PAC ID 9830268671, 124 clinicians

Practice addresses (Care Compare)

1 Audubon Plaza Dr
Louisville, KY 40217-1318
Phone (859) 268-1030

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
St Claire Medical Center, Inc CurrentSince Mar 11, 2017 Accepting new patients
St Claire Medical Center, Inc., Nurse Anesthetist, Certified Registered Current Accepting new patients
Anesthesia Associates, PSC Nurse Anesthetist, Certified Registered CurrentSince Apr 17, 2017 Accepting new patients
Commonwealth Anesthesia, PSC Nurse Anesthetist, Certified Registered CurrentSince Apr 1, 2017 Accepting new patients
St. Claire Medical Center Inc. Nurse Anesthetist, Certified Registered CurrentSince Mar 11, 2017 Accepting new patients

Locations

425 Lewis Hargett Cir
Lexington, KY 40503
Phone (606) 679-9322

1 Saint Joseph Dr
Lexington, KY 40504
Phone (502) 350-5000

310 S Limestone
Lexington, KY 40508
Phone (606) 252-6612

989 Medical Park Dr
Maysville, KY 41056
Phone (606) 759-3112

222 Medical Cir
Morehead, KY 40351
Phone (606) 783-6455

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1452470400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452470400000",
    "number": "1104282805",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 LEWIS HARGETT CIR",
            "city": "LEXINGTON",
            "state": "KY",
            "postal_code": "405033590",
            "telephone_number": "859-268-1030",
            "fax_number": "859-269-4120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 AUDUBON PLAZA DR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402171318",
            "telephone_number": "502-636-7160"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORTIER",
        "first_name": "MATTHEW",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-01-11",
        "last_updated": "2016-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3010010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.