NPIMap

Organization Active NPI

Trident Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Fort Worth, TX
National Provider Identifier
1699218149
Registry record updated Sep 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
802560511 Issued in TX
Legal business name
TRIDENT ANESTHESIA LLC
Practice address
2001 Cooper St
Fort Worth, TX 76104-2529
Phone
(682) 800-1099
NPI assigned
Nov 30, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 2, 2022

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

Authorized official

Name
John Adam Chaucer, CRNANPI 1366688285
Title
Manager
Phone
(817) 727-0985

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X 802560511 TX Primary

Addresses

Primary practice location

2001 Cooper St
Fort Worth, TX 76104-2529

Mailing address

400 10TH St E
Waconia, MN 55387-4552
Phone (682) 297-6708

Other practice location 1

17110 Dallas Pkwy Ste 105
Dallas, TX 75248-1146
Phone (972) 483-5714

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170227001870 TX Part B Supplier - Clinic/Group Practice 3274817879 Receives reassigned benefits from 39 practitioners
Practice locations: Dallas, TX; Fort Worth, TX; Round Rock, TX

National Provider Directory

National Provider Directory

Locations

17950 Preston Rd
Dallas, TX 75252
Phone (972) 267-5400

Practitioners & affiliated clinicians

Practitioners 40

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 40

NPI Registry JSON

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

{
    "created_epoch": "1480464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1662076800000",
    "number": "1699218149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 10TH ST E",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553874552",
            "telephone_number": "682-297-6708",
            "fax_number": "952-442-3620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 COOPER ST",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761042529",
            "telephone_number": "682-800-1099"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17110 Dallas Pkwy Ste 105",
            "address_purpose": "LOCATION",
            "city": "Dallas",
            "state": "TX",
            "postal_code": "752481146",
            "country_code": "US",
            "telephone_number": "972-483-5714",
            "fax_number": "952-442-3620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TRIDENT ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-11-30",
        "last_updated": "2022-09-02",
        "certification_date": "2022-09-02",
        "status": "A",
        "authorized_official_last_name": "CHAUCER",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "ADAM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "817-727-0985",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "802560511",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2022; 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.