Jessica Graham Carroll, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

201360007CRNA Issued in OR

Practice address

1015 NW 22ND Ave
Anesthesia Dept
Portland, OR 97210-3025

Phone

(503) 413-7711

NPI assigned

Nov 19, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jessica Marie Graham Former name

Medicare fee-for-service enrollment

Enrolled in OR, WA2 enrollments

Enrollment records 2

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Anesthetic Solutions IncGroup PAC ID 4587901129, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

Practice roles

Locations

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.

• Anesthetic Solutions, Inc

  • Certified Registered Nurse Anesthetist
  • Medford, OR
  • NPI 1477022259

  Nurse Anesthetist, Certified Registered, OR, WA

  Medicare reassignment Care Compare group NPD
• Columbia Anesthesia Group P S

  • Anesthesiology Physician
  • Vancouver, WA
  • NPI 1861448235

  WA

  Medicare reassignment NPD

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

{
    "created_epoch": "1290124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1392076800000",
    "number": "1750683058",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 NW 22ND AVE",
            "address_2": "ANESTHESIA DEPT",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103025"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 NW 22ND AVE",
            "address_2": "ANESTHESIA DEPT",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972103025",
            "telephone_number": "503-413-7711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARROLL",
        "first_name": "JESSICA",
        "middle_name": "GRAHAM",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-11-19",
        "last_updated": "2014-02-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OR",
            "license": "201360007CRNA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "GRAHAM",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Fay Kaleinani Carroll
• Gregory Carroll, RN, BSN
• Hannah Carroll
• Jamison Keith Carroll, OTR/L
• Jessica Anne Carroll
• Kari D Carroll, MS
• Kevin H. Carroll, M.D.
• McKenna Carroll, M.A., LBA, BCBA
• Megan Molly Carroll, PHARM.D.
• Melissa Ann Carroll, QMHA, CNA

• All providers in Portland, OR
• Certified Registered Nurse Anesthetist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2014; 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.