Individual provider Active NPI

Cody Randy Charlton, CRNA

  • Certified Registered Nurse Anesthetist
  • Farmington, NM
National Provider Identifier
1720182710
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
AP127707 Issued in TX
Practice address
801 W Maple St
Farmington, NM 87401-5630
Phone
(505) 609-2258
Fax
(505) 609-2259
NPI assigned
Sep 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X CRNA-01505 NM
Certified Registered Nurse Anesthetist 367500000X 5130028-4406 UT
Certified Registered Nurse Anesthetist 367500000X AP127707 TX Primary

Addresses

Primary practice location

801 W Maple St
Farmington, NM 87401-5630

Mailing address

PO Box 3570
Salt Lake City, UT 84110-3570
Phone (801) 727-2056

Other practice location 1

1034 N 500 W
Provo, UT 84604-3337
Phone (801) 357-7850

Other practice location 2

28703 Alessandria Cir
Bonita Springs, FL 34135-8277
Phone (801) 471-3893

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, NM, UT3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20150618000185 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 8224349279 Reassigns benefits to 2 organizations
I20171030002168 NM Practitioner - Certified Registered Nurse Anesthetist (Crna) 8224349279 Reassigns benefits to 2 organizations
I20190612002703 UT Practitioner - Certified Registered Nurse Anesthetist (Crna) 8224349279 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Citizens Medical Center County of VictoriaGroup PAC ID 3577785096, 102 clinicians
San Juan Regional Medical Center, Inc.Group PAC ID 4587559505, 233 clinicians

Practice addresses (Care Compare)

2701 Hospital Dr
Victoria, TX 77901-5749
Phone (361) 573-9181

801 W Maple St
Farmington, NM 87401-5630

Hospital & facility affiliations

  • San Juan Regional Medical Center Inc Hospital, Farmington, NM, CCN 320005
  • Citizens Medical Center Hospital, Victoria, TX, CCN 450023

Merit-based Incentive Payment System (MIPS)

Final score
84.26 of 100Reported as group
Quality
74.27
Improvement activities
40
Cost
78.06

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5130028-4406UTMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
San Juan Regional Medical Center Inc CurrentSince Sep 17, 2017 Accepting new patients
Main Street Anesthesia of New Mexico, LLC CurrentSince Sep 11, 2019 Accepting new patients
Mountain View Anesthesia LC CurrentSince Nov 1, 2021 Accepting new patients
Citizen'S Medical Center County of Victoria Family CurrentSince Jul 29, 2024 Accepting new patients
San Juan Regional Medical Center Inc CurrentSince Sep 17, 2017 Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Jan 3, 2023 Accepting new patients
San Juan Regional Medical Center Inc Current Accepting new patients
DHHS, PHS, Naihs, Shiprock Hospital CurrentSince Jan 3, 2023 Accepting new patients
Citizens Medical Center County of Victoria Past Accepting new patients

Locations

601 Martin Luther King Ave NE
Albuquerque, NM 87102
Phone (505) 727-8040

504 Elm St NE
Albuquerque, NM 87102
Phone (505) 724-2000

801 W Maple St
Farmington, NM 87401
Phone (505) 325-5011

117 E 19th St
Roswell, NM 88201
Phone (505) 727-2000

815 N Virginia St
Port Lavaca, TX 77979
Phone (361) 552-0325

2701 Hospital Dr
Fl 6
Victoria, TX 77901
Phone (361) 572-5113

6404 Nursery Dr
Ste 300
Victoria, TX 77904
Phone (361) 570-8311

2701 Hospital Dr
Victoria, TX 77901
Phone (361) 573-9180

96 E Kimballs Ln
Ste 100
Draper, UT 84020
Phone (801) 233-9300

1954 E Fort Union Blvd
Ste 105
Salt Lake Cty, UT 84121
Phone (801) 993-9524

150 W Civic Center Dr
Ste 200
Sandy, UT 84070
Phone (801) 727-2056

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 3

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": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1720182710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3570",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841103570",
            "telephone_number": "801-727-2056",
            "fax_number": "770-701-6675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 W MAPLE ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015630",
            "telephone_number": "505-609-2258",
            "fax_number": "505-609-2259"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1034 N 500 W",
            "address_purpose": "LOCATION",
            "city": "Provo",
            "state": "UT",
            "postal_code": "846043337",
            "country_code": "US",
            "telephone_number": "801-357-7850",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "28703 Alessandria Cir",
            "address_purpose": "LOCATION",
            "city": "Bonita Springs",
            "state": "FL",
            "postal_code": "341358277",
            "country_code": "US",
            "telephone_number": "801-471-3893",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHARLTON",
        "first_name": "CODY",
        "middle_name": "RANDY",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-11",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NM",
            "license": "CRNA-01505",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "UT",
            "license": "5130028-4406",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "AP127707",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2025; 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.