Charles F. Waller, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

564644 Issued in TX

Practice address

321 N Bailey Ave
Fort Worth, TX 76107-1001

Phone

(817) 378-8573

NPI assigned

Feb 7, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

Practice roles

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20286/brand/1/csg/1/fhir/r4

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.

• Beaumont Hospital Holdings Inc

  • Specialist
  • Port Arthur, TX
  • NPI 1790701753
  NPD (past)
• Integrated Medical Professionals 1, LTD

  • Anesthesiology Physician
  • Fort Worth, TX
  • NPI 1336160209
  NPD (past)
• John Peter Smith Hospital

  • Psychiatric Hospital
  • Fort Worth, TX
  • NPI 1760642177
  NPD (past)
• New Anesthesia Practice Service, P.a.

  • Anesthesiology Physician
  • Fort Worth, TX
  • NPI 1770681009
  NPD (past)
• Trinity Pain Medicine Associates PA

  • Interventional Pain Medicine Physician
  • Fort Worth, TX
  • NPI 1275631459
  NPD (past)
• Sheridan Healthcare of North Texas PA

  • Anesthesiology Physician
  • Sunrise, FL
  • NPI 1538142088
  NPD (past)

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

{
    "created_epoch": "1139270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1760455265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 N BAILEY AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761071001",
            "telephone_number": "817-378-8573"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 N BAILEY AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761071001",
            "telephone_number": "817-378-8573"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALLER",
        "first_name": "CHARLES",
        "middle_name": "F.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "564644",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "83479U",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paige Marie Wallace
• Rafaella Izar Wallace, ANP
• Rane Perry Wallace, MS, LPC, LCDC, SAP
• Taron M Wallace, M.S., CCC-SLP
• Emily Wallen, MA, LPC
• Katelyn D'Ann Walley, PTA
• Christine Wallin, RN
• Michele L Wallis, RN
• Walls Universal Home Health & Hospice Services, Inc.
• Amanda Walls, APRN-FNP

• Certified Registered Nurse Anesthetist in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Certified Registered Nurse Anesthetist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.