Wallace Adam Goforth, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

1113831 Issued in TX

Practice address

405 W Jackson St
Carbondale, IL 62901-1462

Phone

(618) 549-0721

NPI assigned

Mar 2, 2017

Last updated

Oct 9, 2025By 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 4

Addresses

Medicare fee-for-service enrollment

Enrolled in LA, TX2 enrollments

Enrollment records 2

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2017

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

Northstar Anesthesia III PAGroup PAC ID 0042630501, 393 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Baylor Scott & White Texas Spine & Joint Hospital Hospital, Tyler, TX, CCN 450864

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• Northstar Anesthesia III PA

  • Anesthesiology Physician
  • Corpus Christi, TX
  • NPI 1356968952

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• U. S. Anesthesia Partners of Texas, P.a.,

  dba Greater Houston Anesthesiology, P.A.

  • Anesthesiology Physician
  • Houston, TX
  • NPI 1548208564

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Willis Knighton Medical Center Inc. Crna Group

  dba Willis Knighton Anesthesia Services

  • Anesthesiology Physician
  • Shreveport, LA
  • NPI 1174546097

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• U S Anesthesia Partners of Texas, PA

  • Interventional Pain Medicine Physician
  • Addison, TX
  • NPI 1053800391

  Nurse Anesthetist, Certified Registered

  NPD
• Brigham Anesthesia South LLC

  • Anesthesiology Physician
  • Carbondale, IL
  • NPI 1699769232
  NPD (past)
• Med-Trans Corporation

  • Air Ambulance
  • Foley, AL
  • NPI 1275084535
  NPD (past)

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

• Texas Spine and Joint Hospital, LLC

  dba Baylor Scott & White TX Spine & Joint Hos Imaging Ctr

  • General Acute Care Hospital
  • Tyler, TX
  • NPI 1942292255
  Care Compare affiliation

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

{
    "created_epoch": "1488412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759968000000",
    "number": "1497295901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "35 ALBANY RD STE C",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629037647",
            "telephone_number": "618-457-5111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 W JACKSON ST",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011462",
            "telephone_number": "618-549-0721"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "12222 Merit Dr Ste 600",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752513294",
            "country_code": "US",
            "telephone_number": "972-715-5000",
            "fax_number": "972-715-9976",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOFORTH",
        "first_name": "WALLACE",
        "middle_name": "ADAM",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-02",
        "last_updated": "2025-10-09",
        "certification_date": "2025-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "1113831",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209016165",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "857695",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.449328",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenzie Lynn Glassburn, MD
• Erin Leigh Gleason
• Kristin Glenn, LPC
• Mary Jane Glisson Keller, ED.S., BCBA
• Jerry L Goddard, M.D.
• Bryan M Goldesberry, DMD
• Portia Goodin, MA, CCC-SLP
• Theresa Aleise Goodin, MA-CCC-SLP
• Katie Ann Gossett, FNP-C
• Kenya Denise Govan

• Certified Registered Nurse Anesthetist in Carbondale, IL
• Providers in Carbondale, IL by specialty
• Certified Registered Nurse Anesthetist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2025; 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.