Individual provider Active NPI

Scott Stewart Carroll, CRNA

  • Certified Registered Nurse Anesthetist
  • Carriere, MS
National Provider Identifier
1740438399
Registry record updated Jun 3, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R780135 Issued in MS
Practice address
33 Scenic Meadow Dr
Carriere, MS 39426-8034
Phone
(601) 569-4818
NPI assigned
Sep 8, 2008
Last updated
Jun 3, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 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 R780135 MS Primary

Addresses

Primary practice location

33 Scenic Meadow Dr
Carriere, MS 39426-8034

Mailing address

33 Scenic Meadow Dr
Carriere, MS 39426-8034
Phone (601) 569-4818

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address scarroll51077@directpatientrecord.com Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120809000764 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 6406002278 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Louisiana State University School of Medicine in New Orleans, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Deep South Anesthesia, IncGroup PAC ID 4284897612, 5 clinicians

Practice addresses (Care Compare)

14225 Dedeaux Rd
Gulfport, MS 39503-3369
Phone (228) 813-0778

801 Goodyear Blvd
Picayune, MS 39466-3221
Phone (601) 798-4711

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R780135MSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Forrest County General Hospital CurrentSince Apr 2, 2014 Accepting new patients
Forrest County General Hospital CurrentSince Apr 2, 2014 Accepting new patients
Deep South Anesthesia, Inc Nurse Anesthetist, Certified Registered CurrentSince Jun 24, 2012 Accepting new patients
Forrest County General Hospital Current Accepting new patients

Locations

1560 Sumrall Rd
Columbia, MS 39429
Phone (601) 736-6303

14225 Dedeaux Rd
Gulfport, MS 39503
Phone (228) 328-0972

6051 U S Highway 49
Hattiesburg, MS 39401
Phone (601) 288-2690

Interoperability endpoints

  • Direct secure messaging: scarroll51077@directpatientrecord.com

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": "1220832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1622678400000",
    "number": "1740438399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 SCENIC MEADOW DR",
            "city": "CARRIERE",
            "state": "MS",
            "postal_code": "394268034",
            "telephone_number": "601-569-4818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 SCENIC MEADOW DR",
            "city": "CARRIERE",
            "state": "MS",
            "postal_code": "394268034",
            "telephone_number": "601-569-4818"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "SCOTT",
        "middle_name": "STEWART",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-08",
        "last_updated": "2021-06-03",
        "certification_date": "2021-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "R780135",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "scarroll51077@directpatientrecord.com",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "415 S 28th Ave",
            "city": "Hattiesburg",
            "state": "MS",
            "country_code": "US",
            "postal_code": "394017246",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Carriere, MS

Sources for this page

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