Active NPI
Roman Shawn Bagwell, CRNA
- Certified Registered Nurse Anesthetist
- Tyler, TX
National Provider Identifier
1689618787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 727514
- Practice address
- 800 E Dawson St
Tyler, TX 75701-2036 - Phone
- (903) 531-4500
- NPI assigned
- Jun 16, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 727514 | TX | Primary |
Addresses
Primary practice location
800 E Dawson St
Tyler, TX 75701-2036
Mailing address
PO Box 841656
Dallas, TX 75284-1656
Phone (903) 531-5000
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 186791301 | Medicaid | TX | |
| 186791303 | Medicaid | TX | |
| 86716U | Other | TX | BCBS |
| TIN PLUS 015 | Other | TX | TRICARE |
| 75-1976930-005 | Other | TX | TRICARE |
| P01246266 | Other | TX | RAIL ROAD |
| 186791302 | Medicaid | TX | |
| 8338UE | Other | TX | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2010 S Jackson St
Christus Mother Frances Hospital Jacksonvil
Jacksonville, TX 75766-5822
Phone (903) 541-4548
2026 S Jackson St
Jacksonville, TX 75766-5822
Hospital & facility affiliations
- Christus Mother Frances Hospital
- Christus Mother Frances Hospital- Jacksonville
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 727514 | TX | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christus Trinity Clinic Texas | Current | Accepting new patients | |
| Trincare Inc | Current | Accepting new patients | |
| East Georgia Regional Medical Center, LLC | Past | Accepting new patients |
Locations
2026 S Jackson St
Jacksonville, TX 75766
Phone (903) 541-4500
800 E Dawson St
Tyler, TX 75701
Phone (903) 531-5018
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.
-
- Critical Access Hospital
- Jacksonville, TX
- NPI 1952306672
-
- General Acute Care Hospital
- Tyler, TX
- NPI 1679578439
-
- Family Medicine Physician
- Tyler, TX
- NPI 1285684225
-
- Clinical Medical Laboratory
- Tyler, TX
- NPI 1033351226
-
- General Acute Care Hospital
- Statesboro, GA
- NPI 1265486278
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Jacksonville, TX
- NPI 1952306672
-
- General Acute Care Hospital
- Tyler, TX
- NPI 1679578439
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150416000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1417996800000",
"number": "1689618787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 841656",
"city": "DALLAS",
"state": "TX",
"postal_code": "752841656",
"telephone_number": "903-531-5000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 E DAWSON ST",
"city": "TYLER",
"state": "TX",
"postal_code": "757012036",
"telephone_number": "903-531-4500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAGWELL",
"first_name": "ROMAN",
"middle_name": "SHAWN",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-16",
"last_updated": "2014-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "TX",
"license": "727514",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "186791301",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "186791303",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "86716U",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "TIN PLUS 015",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "75-1976930-005",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAIL ROAD",
"identifier": "P01246266",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "186791302",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8338UE",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tyler, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2014; 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.