Individual provider Active NPI

Scott A Waggoner, CRNA

  • Certified Registered Nurse Anesthetist
  • Dallas, TX
National Provider Identifier
1336545854
Registry record updated May 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1138853 Issued in TX
Practice address
12222 Merit Dr Ste 600
Dallas, TX 75251-3294
Phone
(972) 715-5000
Fax
(972) 715-9976
NPI assigned
Nov 11, 2014
Last updated
May 6, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 6, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041.425396 IL
Certified Registered Nurse Anesthetist 367500000X 209.012327 IL
Certified Registered Nurse Anesthetist 367500000X 1138853 TX Primary

Addresses

Primary practice location

12222 Merit Dr Ste 600
Dallas, TX 75251-3294

Mailing address

2202 Harlem Rd
Loves Park, IL 61111-2754
Phone (815) 877-4848

Other practice location 1

2202 Harlem Rd
Loves Park, IL 61111-2754
Phone (815) 877-4848

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, TX2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20150306000840 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 5193041317 Reassigns benefits to 2 organizations
I20240503002688 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 5193041317 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
U S Anesthesia Partners of Texas, PAGroup PAC ID 7315850351, 2,750 clinicians

Practice addresses (Care Compare)

1201 W 38TH St
Austin, TX 78705-1006
Phone (512) 324-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.94 of 100Reported as group
Quality
91.31
Improvement activities
40
Cost
79.05

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041.425396ILMDRegistered Nurse
209.012327ILMDCertified Registered Nurse Anesthetist
1138853TXMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
U S Anesthesia Partners of Texas, PA Nurse Anesthetist, Certified Registered CurrentSince May 9, 2024 Accepting new patients
U. S. Anesthesia Partners of Texas, P.a., Nurse Anesthetist, Certified Registered CurrentSince May 9, 2024 Accepting new patients
Rockford Anesthesiologists Associated, L.L.C. Nurse Anesthetist, Certified Registered CurrentSince Jan 26, 2015 Accepting new patients
Rockford Anesthesiologists Associated, L.L.C. CurrentSince Jan 26, 2015 Accepting new patients
Northstar Anesthesia of Illinois, LLC Nurse Anesthetist, Certified Registered CurrentSince Oct 15, 2019 Accepting new patients

Locations

2202 Harlem Rd
Loves Park, IL 61111
Phone (815) 877-4848

2202 Harlem Rd
#200
Loves Park, IL 61111
Phone (815) 877-4848

20201 Crawford Ave
Olympia Flds, IL 60461
Phone (708) 503-3857

1016 Featherstone Rd
Rockford, IL 61107
Phone (815) 226-3300

1401 E State St
Rockford, IL 61104
Phone (815) 489-4267

1423 Chicago Rd
Sauk Village, IL 60411
Phone (708) 679-2160

1201 W 38th St
Austin, TX 78705
Phone (512) 324-1058

4900 Mueller Blvd
Austin, TX 78723
Phone (512) 324-0165

12222 Merit Dr
Ste 600
Dallas, TX 75251
Phone (972) 776-3185

100 Medical Dr
Lake Jackson, TX 77566
Phone (713) 496-7555

9250 Pinecroft Dr
Shenandoah, TX 77380
Phone (281) 364-2300

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1415664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1714953600000",
    "number": "1336545854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2202 HARLEM RD",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611112754",
            "telephone_number": "815-877-4848",
            "fax_number": "815-636-6125"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12222 MERIT DR STE 600",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752513294",
            "telephone_number": "972-715-5000",
            "fax_number": "972-715-9976"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2202 Harlem Rd",
            "address_purpose": "LOCATION",
            "city": "Loves Park",
            "state": "IL",
            "postal_code": "611112754",
            "country_code": "US",
            "telephone_number": "815-877-4848",
            "fax_number": "815-636-6125",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGGONER",
        "first_name": "SCOTT",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-11-11",
        "last_updated": "2024-05-06",
        "certification_date": "2024-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.425396",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209.012327",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "1138853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2024; 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.