Robert V Carrillo, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Fort Scott, KS
NPI 1508879305 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1508879305
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 54133 (KS)
- Practice address
- 401 Woodland Hills Blvd
Fort Scott, KS 66701-8797 - Phone
- (620) 223-2200
- NPI assigned
- Aug 14, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051031000506 | KS | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 5799702510 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 54133 | KS | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospital District No 1 Crawford County | Current | Accepting new patients | |
| Anesthesia Associates of Kansas City PA | Past | Accepting new patients | |
| St Johns Regional Medical Center | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
| St John'S Regional Medical Center | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
| Mercy Kansas Communities Inc | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
| Freeman Neosho Hospital | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
Locations
302 N Hospital Dr
Girard, KS 66743
Phone (620) 724-8291
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 54133 | KS | Yes |
Addresses
Primary practice location
401 Woodland Hills Blvd
Fort Scott, KS 66701-8797
Mailing address
401 Woodland Hills Blvd
Fort Scott, KS 66701-8797
Phone (620) 223-2200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 145207 | Other | KS | BLUE CROSS, PC |
Other providers in Fort Scott, KS
- Kelsey Suzanne Burford
- Katrina M. Burke
- Megan Kathleen Byram
- Courtney Campbell
- William T Carl
- Catherine Carroll
- Choices Psy Services
- Kaylee J Clifton
- Community Health Center of Southeast Kanas, Inc.
- Community Health Center of Southeast Kansas, Inc.
All providers in Fort Scott, KS · Certified Registered Nurse Anesthetist in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.