NPIMap

Organization Active NPI

Anesthesia Associates, PA

  • Anesthesiology Physician
  • Fort Worth, TX
National Provider Identifier
1154317394
Registry record updated Oct 16, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
ANESTHESIA ASSOCIATES, PA
Practice address
4916 Overton PLZ
Fort Worth, TX 76109-4415
Phone
(817) 334-0530
Fax
(817) 334-0235
NPI assigned
Sep 22, 2005
Last updated
Oct 16, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2009

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

Authorized official

Name
Dr. Randall P. Martin, D.O.
Title
President
Phone
(817) 529-1144

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X NU
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

4916 Overton PLZ
Fort Worth, TX 76109-4415

Mailing address

4916 Overton PLZ
Fort Worth, TX 76109-4415
Phone (817) 334-0530

Other identifiers 2

IdentifierTypeStateIssuer
110809403MedicaidTX
110809401MedicaidTX

National Provider Directory

National Provider Directory

Locations

3632 Modlin Ave
Fort Worth, TX 76107
Phone (817) 732-4428

Practitioners & affiliated clinicians

Practitioners 43

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.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255651200000",
    "number": "1154317394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4916 OVERTON PLZ",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094415",
            "telephone_number": "817-334-0530",
            "fax_number": "817-334-0235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4916 OVERTON PLZ",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761094415",
            "telephone_number": "817-334-0530",
            "fax_number": "817-334-0235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANESTHESIA ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2009-10-16",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "RANDALL",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "817-529-1144",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110809403",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110809401",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.