Individual provider Active NPI

Todd Michael Fogarty, CRNA

  • Certified Registered Nurse Anesthetist
  • Oklahoma City, OK
National Provider Identifier
1730289034
Registry record updated Feb 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R0046631 Issued in OK
Practice address
21 NE 3Rd St
Oklahoma City, OK 73104-2205
Phone
(402) 486-7115
Fax
(402) 434-6047
NPI assigned
Sep 25, 2006
Last updated
Feb 18, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 18, 2021

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 R0046631 OK Primary

Addresses

Primary practice location

21 NE 3Rd St
Oklahoma City, OK 73104-2205

Mailing address

21 NE 3Rd St
Oklahoma City, OK 73104-2205
Phone (402) 486-7115

Other identifiers 1

IdentifierTypeStateIssuer
100782930AMedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100525000751 OK Practitioner - Certified Registered Nurse Anesthetist (Crna) 1254460553 Reassigns benefits to 2 organizations
Practice locations: Pauls Valley, OK; Oklahoma City, OK

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

100 Valley Dr
Pauls Valley, OK 73075-6613
Phone (405) 238-5501

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Surgical Hospital of Oklahoma LLC CurrentSince Oct 20, 2023 Accepting new patients
Anesthesia Specialists of Oklahoma, LLC Nurse Anesthetist, Certified Registered Current Accepting new patients
Anesthesia Specialists of Oklahoma LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 31, 2016 Accepting new patients
Hospital for Special Surgery L L C PastSince Jan 31, 2016 Accepting new patients

Locations

100 SE 59th St
Oklahoma City, OK 73129
Phone (405) 364-9789

1044 SW 44th St
Oklahoma City, OK 73109
Phone (405) 631-3085

1044 SW 44th St
Ste 600
Oklahoma City, OK 73109
Phone (405) 631-4263

13100 N Western Ave
Ste 200
Oklahoma City, OK 73114
Phone (405) 208-9097

2825 Parklawn Dr
Oklahoma City, OK 73110
Phone (405) 245-1453

Organizations & group practices 4

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.

Hospital & facility affiliations 1

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": "1159142400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613606400000",
    "number": "1730289034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 NE 3RD ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731042205",
            "telephone_number": "402-486-7115",
            "fax_number": "402-434-6047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 NE 3RD ST",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731042205",
            "telephone_number": "402-486-7115",
            "fax_number": "402-434-6047"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FOGARTY",
        "first_name": "TODD",
        "middle_name": "MICHAEL",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-25",
        "last_updated": "2021-02-18",
        "certification_date": "2021-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OK",
            "license": "R0046631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100782930A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2021; 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.