Timothy Phan, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

CRNA000265 Issued in NV

Practice address

330 S Lola LN
Suite 200
Pahrump, NV 89048-0878

Phone

(775) 751-7500

Fax

(775) 751-7824

NPI assigned

Aug 17, 2005

Last updated

Dec 20, 2016By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• John T Goodsell DO PC Gregory Linderer MD LTD

  dba Anesthesia Associates

  • Anesthesiology Physician
  • Henderson, NV
  • NPI 1427000413
  NPD (past)
• Anesthesia Associates of the Rockies LLC

  • Anesthesiology Physician
  • Lakewood, CO
  • NPI 1962739003
  NPD (past)

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

{
    "created_epoch": "1124236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482192000000",
    "number": "1417949314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7385 S PECOS RD",
            "address_2": "STE 103",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891203768",
            "telephone_number": "888-221-2297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "330 S LOLA LN",
            "address_2": "SUITE 200",
            "city": "PAHRUMP",
            "state": "NV",
            "postal_code": "890480878",
            "telephone_number": "775-751-7500",
            "fax_number": "775-751-7824"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHAN",
        "first_name": "TIMOTHY",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-17",
        "last_updated": "2016-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NV",
            "license": "CRNA000265",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100505726",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mahadai Persaud
• Destaney Peters
• Pamela Kay Petersen
• Maria H Petras, NP-C
• PFL PLLC
• Dawn Phillips
• Michael David Phillips, LICSW
• Solange E Phillips
• Charlene Phung
• Physicians Choice Home Health Care, Inc

• Certified Registered Nurse Anesthetist in Pahrump, NV
• Providers in Pahrump, NV by specialty
• Certified Registered Nurse Anesthetist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.