Carlan A Wilson Jr., CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

050274 Issued in TN

Practice address

607 W Main St
Grangeville, ID 83530-1345

Phone

(208) 983-1700

NPI assigned

Jan 16, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

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.

• Syringa General Hospital District C I F

  • Critical Access Hospital
  • Grangeville, ID
  • NPI 1750336608
  Medicare reassignment
• American Anesthesiology Group of Tennessee, P. C.

  • Anesthesiology Physician
  • Kingsport, TN
  • NPI 1114927738

  Nurse Anesthetist, Certified Registered

  NPD (past)
• Collier Anesthesia PA

  • Anesthesiology Physician
  • Naples, FL
  • NPI 1649251745
  NPD (past)

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1312416000000",
    "number": "1326199092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 E BROADWAY ST STOP 2",
            "address_2": "PMB 629",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024914",
            "telephone_number": "239-285-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "607 W MAIN ST",
            "city": "GRANGEVILLE",
            "state": "ID",
            "postal_code": "835301345",
            "telephone_number": "208-983-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "CARLAN",
        "middle_name": "A",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2011-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "050274",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807009800",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "HBLS1",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tolo Tranportation LLC
• Tolo Transportation
• Bradi Morel Voigt Trapp, PA-C
• Two Rivers Family & Cosmetic Dentistry, PA
• Valleyview Recovery
• Kelby Jon Wilson, MD
• Nathan T Winder, MHS PA-C
• Derek R Wynn, PA

• Certified Registered Nurse Anesthetist in Grangeville, ID
• Providers in Grangeville, ID by specialty
• Certified Registered Nurse Anesthetist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.