Active NPI
Watcharasarn Rattananan, MD
- Clinical Neurophysiology Physician
- Henderson, NV
National Provider Identifier
1760612659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neurophysiology Physician
- License
- 17053
- Practice address
- 201 S Gibson Rd Apt 1208
Henderson, NV 89012-2660 - Phone
- (615) 345-5400
- Fax
- (888) 468-6603
- NPI assigned
- Jul 25, 2009
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician | 2084N0400X | MD2019-0793 | NM | |
| Neurology Physician | 2084N0400X | 17053 | NV | |
| Clinical Neurophysiology Physician | 2084N0600X | 17053 | NV | Primary |
Addresses
Primary practice location
201 S Gibson Rd Apt 1208
Henderson, NV 89012-2660
Mailing address
3 Maryland Farms Ste 200
Brentwood, TN 37027-5005
Phone (615) 345-5400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| MD2019-0793 | Other | NM | NEW MEXICO MEDICAL BOARD |
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
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD2019-0793 | NM | MD | Neurology Physician |
| 17053 | NV | MD | Clinical Neurophysiology Physician |
Interoperability endpoints
- wrattananan387428@direct.multicare.org
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598918400000",
"number": "1760612659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3 MARYLAND FARMS STE 200",
"city": "BRENTWOOD",
"state": "TN",
"postal_code": "370275005",
"telephone_number": "615-345-5400",
"fax_number": "888-468-6603"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 S GIBSON RD APT 1208",
"city": "HENDERSON",
"state": "NV",
"postal_code": "890122660",
"telephone_number": "615-345-5400",
"fax_number": "888-468-6603"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RATTANANAN",
"first_name": "WATCHARASARN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-07-25",
"last_updated": "2020-09-01",
"certification_date": "2020-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NM",
"license": "MD2019-0793",
"primary": false
},
{
"code": "2084N0400X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Neurology",
"state": "NV",
"license": "17053",
"primary": false
},
{
"code": "2084N0600X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Clinical Neurophysiology",
"state": "NV",
"license": "17053",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW MEXICO MEDICAL BOARD",
"identifier": "MD2019-0793",
"state": "NM"
}
],
"endpoints": [],
"other_names": []
}Other providers in Henderson, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.