Active NPI
Russell G Worthen, CRNA
- Certified Registered Nurse Anesthetist
- Payson, UT
National Provider Identifier
1760586234
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 361659-4406
- Practice address
- 1000 E 100 N
Payson, UT 84651-1600 - Phone
- (800) 748-4868
- Fax
- (801) 733-5872
- NPI assigned
- Sep 12, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 361659-4406 | UT | Primary |
Addresses
Primary practice location
1000 E 100 N
Payson, UT 84651-1600
Mailing address
383 W 1600 S
Payson, UT 84651-8614
Phone (801) 465-2424
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 107043317101 | Other | UT | IHC |
| 67790 | Other | UT | HEALTHY U |
| QMP000003333387 | Other | UT | MOLINA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 361659-4406 | UT | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cataract & Lasik Center of Utah PC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba dba Cataract Center of Utah
- Ophthalmology Physician
- Pleasant Grove, UT
- NPI 1447378302
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158019200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1760586234",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "383 W 1600 S",
"city": "PAYSON",
"state": "UT",
"postal_code": "846518614",
"telephone_number": "801-465-2424"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 E 100 N",
"city": "PAYSON",
"state": "UT",
"postal_code": "846511600",
"telephone_number": "800-748-4868",
"fax_number": "801-733-5872"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WORTHEN",
"first_name": "RUSSELL",
"middle_name": "G",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-09-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "UT",
"license": "361659-4406",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IHC",
"identifier": "107043317101",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHY U",
"identifier": "67790",
"state": "UT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MOLINA",
"identifier": "QMP000003333387",
"state": "UT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Payson, UT
Sources for this page
- 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.