Individual provider Active NPI

Clay Rougeau, CRNA

  • Anesthesiology Physician
  • Conway, AR
National Provider Identifier
1629065032
Registry record updated Mar 13, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
C00616 Issued in AR
Practice address
525 Western Ave
Suite 201
Conway, AR 72034-4967
Phone
(501) 327-6665
Fax
(501) 730-0289
NPI assigned
Sep 30, 2005
Last updated
Mar 13, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X C00616 AR Primary

Addresses

Primary practice location

525 Western Ave
Suite 201
Conway, AR 72034-4967

Mailing address

525 Western Ave
Suite 201
Conway, AR 72034-4967
Phone (501) 327-6665

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AR

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040331000604 AR Practitioner - Certified Registered Nurse Anesthetist (Crna) 1456343433 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ozark Health, Inc Current Accepting new patients
Rougeau Group P a Past Accepting new patients
Stuttgart Regional Medical Center Past Accepting new patients
Stuttgart Regional Medical Center Past Accepting new patients
Baptist Memorial Hospital-Jonesboro Inc Past Accepting new patients
Conway Anesthesiology Consultants, P.a. Anesthesiology PastSince Sep 29, 2003 Accepting new patients
Northeast Arkansas Health System LLC Past Accepting new patients

Locations

2500 Highway 65 S
Clinton, AR 72031
Phone (501) 745-7000

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205366400000",
    "number": "1629065032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "525 WESTERN AVE",
            "address_2": "SUITE 201",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720344967",
            "telephone_number": "501-327-6665",
            "fax_number": "501-730-0289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 WESTERN AVE",
            "address_2": "SUITE 201",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720344967",
            "telephone_number": "501-327-6665",
            "fax_number": "501-730-0289"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUGEAU",
        "first_name": "CLAY",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-30",
        "last_updated": "2008-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AR",
            "license": "C00616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.