Active NPI
Richard Anthony Wallace, CRNA
- Certified Registered Nurse Anesthetist
- Harriman, TN
National Provider Identifier
1629031992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 9332
- Practice address
- 8045 Roane Medical Center Dr
Harriman, TN 37748-8333 - Phone
- (865) 316-1000
- NPI assigned
- Apr 8, 2006
- Last updated
- Sep 25, 2013
- 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 | 9332 | TN | Primary |
Addresses
Primary practice location
8045 Roane Medical Center Dr
Harriman, TN 37748-8333
Mailing address
969 Oak Ridge Tpke # 316
Oak Ridge, TN 37830-8832
Phone (865) 256-7711
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0454102553 | Other | TN | TRICARE SOUTH HUMANA MILITARY |
| 4317478 | Other | TN | BCBS - COVER TENNESSEE |
| 4317478 | Other | TN | BCBS - MEDICARE ADVANTAGE (BLUEADVANTAGE) |
| 616644300 | Other | TN | DEPT OF LABOR WORKER'S COMP - DEEOIC PROGRAM |
| 171975592453 | Other | TN | HUMANA |
| 4317478 | Other | TN | BCBS - BLUE SELECT |
| 3037582 | Other | TN | CIGNA |
| 4317478 | Other | TN | BCBS - TENNCARE SELECT |
| 4317478 | Other | TN | BCBS - BLUE PREFERRED |
| 1527480 | Other | TN | TENNCARE, EFFECTIVE 4/5/12 |
| 1527480 | Medicaid | TN | |
| 4317478 | Other | TN | BCBS - BLUECARE |
| 454102553 | Other | TN | HUMANA GOLD |
| 616644300 | Other | TN | DEPT OF LABOR WOKER'S COMP - FECA PROGRAM |
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 |
|---|---|---|---|
| 9332 | TN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Anesthesiology of Tennessee, P.C. | Past | Accepting new patients | |
| Covenant Anesthesia Group, PC | Past | Accepting new patients | |
| Nurse Anesthesia of North Carolina, PLLC | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Anesthesiology Physician
- Knoxville, TN
- NPI 1609822998
-
dba MMC Anesthesia Group, PC
- Anesthesiology Physician
- Oak Ridge, TN
- NPI 1639148117
-
- Certified Registered Nurse Anesthetist
- Elizabeth City, NC
- NPI 1689628729
Nurse Anesthetist, Certified Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144454400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380067200000",
"number": "1629031992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "969 OAK RIDGE TPKE # 316",
"city": "OAK RIDGE",
"state": "TN",
"postal_code": "378308832",
"telephone_number": "865-256-7711",
"fax_number": "866-548-0571"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8045 ROANE MEDICAL CENTER DR",
"city": "HARRIMAN",
"state": "TN",
"postal_code": "377488333",
"telephone_number": "865-316-1000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALLACE",
"first_name": "RICHARD",
"middle_name": "ANTHONY",
"credential": "CRNA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-08",
"last_updated": "2013-09-25",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "TN",
"license": "9332",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE SOUTH HUMANA MILITARY",
"identifier": "0454102553",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS - COVER TENNESSEE",
"identifier": "4317478",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS - MEDICARE ADVANTAGE (BLUEADVANTAGE)",
"identifier": "4317478",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF LABOR WORKER'S COMP - DEEOIC PROGRAM",
"identifier": "616644300",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "171975592453",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS - BLUE SELECT",
"identifier": "4317478",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "3037582",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS - TENNCARE SELECT",
"identifier": "4317478",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS - BLUE PREFERRED",
"identifier": "4317478",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TENNCARE, EFFECTIVE 4/5/12",
"identifier": "1527480",
"state": "TN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1527480",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS - BLUECARE",
"identifier": "4317478",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA GOLD",
"identifier": "454102553",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPT OF LABOR WOKER'S COMP - FECA PROGRAM",
"identifier": "616644300",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Harriman, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.