Individual provider Active NPI

Rosalie Marie Gwaltney, CRNA

  • Anesthesiology Physician
  • Lovington, NM
National Provider Identifier
1376645598
Registry record updated Sep 2, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
CRNA00756 Issued in NM
Practice address
1600 North Main
Lovington, NM 88260-2830
Phone
(575) 396-6611
Fax
(575) 396-1454
NPI assigned
Sep 1, 2006
Last updated
Sep 2, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 044788RN MO
Anesthesiology Physician 207L00000X CRNA00756 NM Primary

Addresses

Primary practice location

1600 North Main
Lovington, NM 88260-2830

Mailing address

1600 North Main
Lovington, NM 88260-2830
Phone (575) 396-6611

Other identifiers 1

IdentifierTypeStateIssuer
44235097MedicaidNM

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040210001155 NM Practitioner - Certified Registered Nurse Anesthetist (Crna) 9234023284 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
044788RNMOMDAnesthesiology Physician
CRNA00756NMMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Nor-Lea Hospital District CurrentSince Jul 29, 2013 Accepting new patients
Freeman Neosho Hospital Anesthesiology Past Accepting new patients
Roswell Hospital Corporation Past Accepting new patients
Verde Valley Medical Center Past Accepting new patients
Deming Hospital Corporation Anesthesiology Past Accepting new patients
Mercy Kansas Communities Inc Past Accepting new patients
Roswell Hospital Corporation Past Accepting new patients
San Miguel Hospital Corporation Past Accepting new patients
Frances Mahon Deaconess Hospital Past Accepting new patients

Locations

515 E Main St
Hobbs, NM 88240
Phone (575) 397-0560

1600 N Main Ave
Lovington, NM 88260
Phone (575) 396-6611

1600 N Main Ave
Ste A
Lovington, NM 88260
Phone (505) 396-3529

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1157068800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472774400000",
    "number": "1376645598",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 NORTH MAIN",
            "city": "LOVINGTON",
            "state": "NM",
            "postal_code": "882602830",
            "telephone_number": "575-396-6611",
            "fax_number": "575-396-1454"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 NORTH MAIN",
            "city": "LOVINGTON",
            "state": "NM",
            "postal_code": "882602830",
            "telephone_number": "575-396-6611",
            "fax_number": "575-396-1454"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GWALTNEY",
        "first_name": "ROSALIE",
        "middle_name": "MARIE",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-01",
        "last_updated": "2016-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "044788RN",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NM",
            "license": "CRNA00756",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "44235097",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lovington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2016; 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.