Active NPI
Ronald L Brockett, CRNA
- Certified Registered Nurse Anesthetist
- Romney, WV
National Provider Identifier
1104996438
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 28779
- Practice address
- 549 Center Ave
Romney, WV 26757-1352 - Phone
- (304) 822-4651
- Fax
- (304) 822-7809
- NPI assigned
- Nov 8, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 28779 | WV | Primary |
Addresses
Primary practice location
549 Center Ave
Romney, WV 26757-1352
Mailing address
549 Center Ave
Romney, WV 26757-1352
Phone (304) 822-4651
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0068380000 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28779 | WV | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104996438",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "549 CENTER AVE",
"city": "ROMNEY",
"state": "WV",
"postal_code": "267571352",
"telephone_number": "304-822-4651",
"fax_number": "304-822-7809"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "549 CENTER AVE",
"city": "ROMNEY",
"state": "WV",
"postal_code": "267571352",
"telephone_number": "304-822-4651",
"fax_number": "304-822-7809"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROCKETT",
"first_name": "RONALD",
"middle_name": "L",
"credential": "CRNA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-08",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "WV",
"license": "28779",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0068380000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Romney, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.