Individual provider Active NPI

Danny Joe Roth, CRNA, APN

  • Certified Registered Nurse Anesthetist
  • Fairbanks, AK
National Provider Identifier
1164504403
Registry record updated Sep 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
384 Issued in AK
Practice address
1650 Cowles St
Fairbanks, AK 99701-5998
Phone
(907) 388-6852
NPI assigned
Oct 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 12213 TN
Certified Registered Nurse Anesthetist 367500000X 384 AK Primary

Addresses

Primary practice location

1650 Cowles St
Fairbanks, AK 99701-5998

Mailing address

2460 Topeka Drive
North Pole, AK 99705-2460
Phone (423) 315-6338

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230418000936 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 0446202717 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2525 Desales Ave
Chattanooga, TN 37404-1161
Phone (865) 546-8040

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
384AKMDDentist
12213TNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of Tennessee, P.C. Nurse Anesthetist, Certified Registered CurrentSince Jul 18, 2023 Accepting new patients
American Anesthesiology of Tennessee, P.C. CurrentSince Jul 18, 2023 Accepting new patients
Fairbanks Anesthesia Inc. PastSince Jan 1, 2000 Accepting new patients

Locations

2525 Desales Ave
Chattanooga, TN 37404
Phone (423) 495-2620

9300 Park West Blvd
Knoxville, TN 37923
Phone (865) 427-4040

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1164504403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2460 TOPEKA DRIVE",
            "city": "NORTH POLE",
            "state": "AK",
            "postal_code": "997052460",
            "telephone_number": "423-315-6338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1650 COWLES ST",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015998",
            "telephone_number": "907-388-6852"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "DANNY",
        "middle_name": "JOE",
        "name_prefix": "Mr.",
        "credential": "CRNA, APN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "12213",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AK",
            "license": "384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairbanks, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; 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.