Individual provider Active NPI

Kevin Matthew Tirado Roman

  • Certified Registered Nurse Anesthetist
  • Durham, NC
National Provider Identifier
1710461694
Registry record updated Oct 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
124099 Issued in NC
Practice address
2301 Edwin Rd
Durham, NC 27710-0001
Phone
(919) 684-8111
NPI assigned
Sep 18, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 124099 NC Primary

Addresses

Primary practice location

2301 Edwin Rd
Durham, NC 27710-0001

Mailing address

504 E Pettigrew St Apt 249
Durham, NC 27701-4467

Other practice location 1

1010 College St
Oxford, NC 27565-2507
Phone (919) 690-3000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190118000766 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 1355687914 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Carolina Anesthesia Associates PLLCGroup PAC ID 5092720813, 691 clinicians

Practice addresses (Care Compare)

1001 W Williams St
Suite 103
Apex, NC 27502-3978
Phone (919) 439-7867

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
124099NCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Nash Hospitals Inc CurrentSince Apr 1, 2022 Accepting new patients
Granville Health System Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2022 Accepting new patients
Duke University Health System, Inc. CurrentSince Nov 3, 2018 Accepting new patients
Duke University Health System, Inc. Nurse Anesthetist, Certified Registered Current Accepting new patients
Granville Health System CurrentSince Aug 1, 2022 Accepting new patients
East Carolina Anesthesia Associates, PLLC Anesthesiology CurrentSince Sep 1, 2024 Accepting new patients
Duke University Health System, Inc. CurrentSince Nov 3, 2018 Accepting new patients
Raleigh Medical Group, PA CurrentSince May 15, 2019 Accepting new patients
Nash Hospitals Inc Nurse Anesthetist, Certified Registered CurrentSince Apr 1, 2022 Accepting new patients

Locations

1001 W Williams St
Ste 103
Apex, NC 27502
Phone (919) 363-2111

2301 Erwin Rd
Durham, NC 27705
Phone (919) 668-0289

3643 N Roxboro St
Durham, NC 27704
Phone (919) 470-6186

2430 Emerald Pl
Ste 103
Greenville, NC 27834
Phone (252) 752-2140

1010 College St
Oxford, NC 27565
Phone (919) 623-5115

3521 Haworth Dr
Raleigh, NC 27609
Phone (919) 782-1806

2601 Lake Dr
Ste 201
Raleigh, NC 27607
Phone (919) 783-4888

2460 Curtis Ellis Dr
Rocky Mount, NC 27804
Phone (252) 443-8199

Organizations & group practices 9

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1537228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729296000000",
    "number": "1710461694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 E PETTIGREW ST APT 249",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277014467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 EDWIN RD",
            "city": "DURHAM",
            "state": "NC",
            "postal_code": "277100001",
            "telephone_number": "919-684-8111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1010 College St",
            "address_purpose": "LOCATION",
            "city": "Oxford",
            "state": "NC",
            "postal_code": "275652507",
            "country_code": "US",
            "telephone_number": "919-690-3000",
            "fax_number": "919-690-3213",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TIRADO ROMAN",
        "first_name": "KEVIN",
        "middle_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-09-18",
        "last_updated": "2024-10-19",
        "certification_date": "2024-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "124099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Durham, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 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.

Verify at the official NPI Registry.