Active NPI
Robert Eugene Wise, CRNA
- Certified Registered Nurse Anesthetist
- Cedar City, UT
National Provider Identifier
1558492637
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 5586107-4406
- Practice address
- 195 E Fiddlers Canyon Rd
Unit 14
Cedar City, UT 84720-8744 - Phone
- (435) 559-3136
- NPI assigned
- Mar 8, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 5586107-4406 | UT | Primary |
Addresses
Primary practice location
195 E Fiddlers Canyon Rd
Unit 14
Cedar City, UT 84720-8744
Mailing address
195 E Fiddlers Canyon Rd
Unit 14
Cedar City, UT 84720-8744
Phone (435) 559-3136
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 86924214 | Medicaid | NM | |
| P00469890 | Other | NM | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5586107-4406 | UT | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Montana Medical Facilities, Inc | Past | Accepting new patients | |
| Central Montana Medical Facilities, Inc. | Past | Accepting new patients | |
| Medical Center Medical Group | Past | Accepting new patients | |
| Roswell Clinic Corp | Past | Accepting new patients |
Organizations & group practices 4
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba Central Montana Medical Center
- Critical Access Hospital
- Lewistown, MT
- NPI 1790798387
-
dba Central Montana Medical Center Clinic
- Family Medicine Physician
- Lewistown, MT
- NPI 1497868814
-
- Anesthesiology Physician
- Texarkana, TX
- NPI 1720046444
-
- Family Medicine Physician
- Roswell, NM
- NPI 1649267618
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1217376000000",
"number": "1558492637",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "195 E FIDDLERS CANYON RD",
"address_2": "UNIT 14",
"city": "CEDAR CITY",
"state": "UT",
"postal_code": "847208744",
"telephone_number": "435-559-3136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "195 E FIDDLERS CANYON RD",
"address_2": "UNIT 14",
"city": "CEDAR CITY",
"state": "UT",
"postal_code": "847208744",
"telephone_number": "435-559-3136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISE",
"first_name": "ROBERT",
"middle_name": "EUGENE",
"name_prefix": "Mr.",
"credential": "CRNA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-08",
"last_updated": "2008-07-30",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "UT",
"license": "5586107-4406",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "86924214",
"state": "NM"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00469890",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cedar City, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.