Individual provider Active NPI

Roxann Latoya Shaw, CRNA

  • Certified Registered Nurse Anesthetist
  • Lawrenceville, GA
National Provider Identifier
1265660252
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN176302 Issued in GA
Practice address
1000 Medical Center Blvd
Lawrenceville, GA 30046-7694
Phone
(678) 312-1000
Fax
(678) 312-3282
NPI assigned
Jun 29, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 26, 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 RN 9254117 FL
Certified Registered Nurse Anesthetist 367500000X RN176302 GA Primary

Addresses

Primary practice location

1000 Medical Center Blvd
Lawrenceville, GA 30046-7694

Mailing address

1000 Medical Center Blvd
Lawrenceville, GA 30046-7694
Phone (678) 312-1000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110112000665 AR Practitioner - Certified Registered Nurse Anesthetist (Crna) 2264579127 Reassigns benefits to 2 organizations
I20210122001574 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 2264579127 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Atlanta Anesthesia Professionals, LLCGroup PAC ID 5496134348, 543 clinicians

Practice addresses (Care Compare)

1000 Medical Ctr Blvd
Lawrenceville, GA 30046-7694
Phone (678) 312-1000

Hospital & facility affiliations

  • Northside Hospital Duluth Hospital, Duluth, GA, CCN 110252

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
RN 9254117FLMDCertified Registered Nurse Anesthetist
RN176302GAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Dpi of Georgia, LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 11, 2022 Accepting new patients
Southern Regional Anesthesiology Consultants PLLC CurrentSince Dec 9, 2019 Accepting new patients
Sentry Anesthesia Management, LLC CurrentSince Oct 17, 2022 Accepting new patients
Johnson Regional Medical Center CurrentSince Apr 21, 2021 Accepting new patients
North Atlanta Anesthesia Professionals, LLC CurrentSince Nov 11, 2022 Accepting new patients
Johnson Regional Medical Center CurrentSince Apr 21, 2021 Accepting new patients
CSP Anesthesia LLC CurrentSince Jan 19, 2021 Accepting new patients
Ascent Home Health and Hospice Inc. PastSince Feb 25, 2014 Accepting new patients
Eastpointe Medical Clinic Inc PastSince Oct 7, 2015 Accepting new patients
Northeast Arkansas Clinic Charitable Foundation, Inc. Past Accepting new patients

Locations

1100 E Poplar St
Ste B
Clarksville, AR 72830
Phone (479) 754-5454

500 S University Ave
Ste 500
Little Rock, AR 72205
Phone (501) 320-1101

2 Saint Vincent Cir
Little Rock, AR 72205
Phone (501) 552-2680

4 Hospital Dr
Morrilton, AR 72110
Phone (501) 977-2300

126 US Highway 280 W
Americus, GA 31719
Phone (229) 924-6011

960 Joe Frank Harris Pkwy SE
Cartersville, GA 30120
Phone (404) 554-2196

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

300 Colonial Center Pkwy
Ste 100N
Roswell, GA 30076
Phone (704) 684-7609

5505 Roswell Rd
Ste 350B
Sandy Springs, GA 30342

1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737

403 Permian Way
Ste D
Villa Rica, GA 30180
Phone (470) 827-3648

Organizations & group practices 11

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1246233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682467200000",
    "number": "1265660252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 MEDICAL CENTER BLVD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300467694",
            "telephone_number": "678-312-1000",
            "fax_number": "678-312-3282"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MEDICAL CENTER BLVD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300467694",
            "telephone_number": "678-312-1000",
            "fax_number": "678-312-3282"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAW",
        "first_name": "ROXANN",
        "middle_name": "LATOYA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-29",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "RN 9254117",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN176302",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 26, 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.