Active NPI
Clifford E. Queen, CRNA
- Certified Registered Nurse Anesthetist
- Gallipolis, OH
National Provider Identifier
1205852894
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 155948
- Practice address
- 100 Jackson Pike
Gallipolis, OH 45631-1560 - Phone
- (740) 446-5238
- Fax
- (740) 441-8058
- NPI assigned
- Jul 15, 2006
- Sex
- Male
- Sole proprietor
- No
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 | 155948 | OH | Primary |
Addresses
Primary practice location
100 Jackson Pike
Gallipolis, OH 45631-1560
Mailing address
90 Jackson Pike
Gallipolis, OH 45631-1560
Phone (740) 441-1949
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000000006912 | Other | ANTHEM BCBS | |
| 0065208000 | Medicaid | WV | |
| 430028924 | Other | RR MEDICARE | |
| 001714073 | Other | MOUNTAIN STATE BCBS | |
| 0752118 | Other | OH | MOLINA MEDICAID |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | clifford.queen.1@17389.direct.athenahealth.com |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 155948 | OH | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152921600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1606089600000",
"number": "1205852894",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 JACKSON PIKE",
"city": "GALLIPOLIS",
"state": "OH",
"postal_code": "456311560",
"telephone_number": "740-441-1949",
"fax_number": "740-446-5982"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 JACKSON PIKE",
"city": "GALLIPOLIS",
"state": "OH",
"postal_code": "456311560",
"telephone_number": "740-446-5238",
"fax_number": "740-441-8058"
}
],
"practiceLocations": [],
"basic": {
"last_name": "QUEEN",
"first_name": "CLIFFORD",
"middle_name": "E.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-15",
"last_updated": "2020-11-23",
"certification_date": "2020-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "OH",
"license": "155948",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM BCBS",
"identifier": "000000006912",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0065208000",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "430028924",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOUNTAIN STATE BCBS",
"identifier": "001714073",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOLINA MEDICAID",
"identifier": "0752118",
"state": "OH"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "clifford.queen.1@17389.direct.athenahealth.com",
"affiliation": "N",
"address_1": "100 Jackson Pike",
"city": "Gallipolis",
"state": "OH",
"country_code": "US",
"postal_code": "456311560",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Gallipolis, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.