Active NPI
Justin T Vaughn, CRNA
- Certified Registered Nurse Anesthetist
- Tacoma, WA
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- AP300007207
- Practice address
- 9040 Jackson Ave Madigan Army Medical Center
Tacoma, WA 98431-0001 - Phone
- (253) 968-1110
- NPI assigned
- May 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Registered Nurse | 163WG0000X | RN00162696 | WA | |
| Certified Registered Nurse Anesthetist | 367500000X | AP300007207 | WA | Primary |
Addresses
Primary practice location
9040 Jackson Ave Madigan Army Medical Center
Tacoma, WA 98431-0001
Mailing address
Madigan Army Medical Ctr
9040 A Reid St
Tacoma, WA 98431-0001
Phone (253) 968-1110
Other practice location 1
209 Lilly Rd NE
Olympia, WA 98506-5030
Phone (360) 413-8250
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3350VA | Other | WA | INDIVIDUAL BLUE SHIELD |
| 0039515 | Other | WA | L&I |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Public Hospital District No 1 of Mason County
Practice addresses (Care Compare)
901 Mountain View Dr
Suite 1
Shelton, WA 98584-4401
Phone (360) 427-3625
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN00162696 | WA | MD | General Practice Registered Nurse |
| AP300007207 | WA | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Gastroenterology Associates Clinical Practice, PLLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Texas Anesthesia Specialists PA | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
| Narrows Anesthesia Services PLLC | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
Locations
209 Lilly Rd NE
Olympia, WA 98506
Phone (360) 413-8250
Organizations & group practices 5
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.
-
- Gastroenterology Physician
- Olympia, WA
- NPI 1811556442
Nurse Anesthetist, Certified Registered
-
- Certified Registered Nurse Anesthetist
- Shelton, WA
- NPI 1164650032
-
- Critical Access Hospital
- Shelton, WA
- NPI 1760568752
-
- Anesthesiology Physician
- Tacoma, WA
- NPI 1801026315
Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- El Paso, TX
- NPI 1710124490
Nurse Anesthetist, Certified Registered
Hospital & facility affiliations 5
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Shelton, WA
- NPI 1760568752
-
- Foot & Ankle Surgery Podiatrist
- Shelton, WA
- NPI 1437486248
Hospital
-
- Surgery Physician
- Shelton, WA
- NPI 1639339666
Hospital
-
- Ophthalmologic Surgery Clinic/Center
- Shelton, WA
- NPI 1922196609
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147392000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724198400000",
"number": "1568412096",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "MADIGAN ARMY MEDICAL CTR",
"address_2": "9040 A REID ST",
"city": "TACOMA",
"state": "WA",
"postal_code": "984310001",
"telephone_number": "253-968-1110"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9040 JACKSON AVE MADIGAN ARMY MEDICAL CENTER",
"city": "TACOMA",
"state": "WA",
"postal_code": "984310001",
"telephone_number": "253-968-1110"
}
],
"practiceLocations": [
{
"address_1": "209 Lilly Rd NE",
"address_purpose": "LOCATION",
"city": "Olympia",
"state": "WA",
"postal_code": "985065030",
"country_code": "US",
"telephone_number": "360-413-8250",
"fax_number": "360-413-8850",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "VAUGHN",
"first_name": "JUSTIN",
"middle_name": "T",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-12",
"last_updated": "2024-08-21",
"certification_date": "2024-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "163WG0000X",
"taxonomy_group": "",
"desc": "Registered Nurse, General Practice",
"state": "WA",
"license": "RN00162696",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "WA",
"license": "AP300007207",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIVIDUAL BLUE SHIELD",
"identifier": "3350VA",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "L&I",
"identifier": "0039515",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; 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.