Individual provider Active NPI

Dallas John Vogt, CRNA

  • Certified Registered Nurse Anesthetist
  • Council Bluffs, IA
National Provider Identifier
1770042012
Registry record updated Mar 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
D154087 Issued in IA
Practice address
201 Ridge St Ste 201
Council Bluffs, IA 51503-4643
Phone
(712) 322-5565
NPI assigned
Mar 17, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2019

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 D154087 IA Primary

Addresses

Primary practice location

201 Ridge St Ste 201
Council Bluffs, IA 51503-4643

Mailing address

201 Ridge St Ste 201
Council Bluffs, IA 51503-4643
Phone (712) 322-5565

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190416002465 IA Practitioner - Certified Registered Nurse Anesthetist (Crna) 0648511808 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Jennie Edmundson Memorial HospitalGroup PAC ID 9537064837, 59 clinicians

Practice addresses (Care Compare)

933 E Pierce St
Council Bluffs, IA 51503-4626
Phone (712) 396-6111

Hospital & facility affiliations

  • Methodist Jennie Edmundson Hospital, Council Bluffs, IA, CCN 160047

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D154087IAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Jennie Edmundson Memorial Hospital CurrentSince Jan 31, 2024 Accepting new patients

Locations

201 Ridge St
Ste 201
Council Bluffs, IA 51503
Phone (712) 322-5899

933 E Pierce St
Council Bluffs, IA 51503
Phone (712) 328-6000

201 Ridge St
Ste 102
Council Bluffs, IA 51503
Phone (712) 396-4359

825 S 169th St
Omaha, NE 68118
Phone (402) 354-3370

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 and National Provider Directory roles.

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": "1552780800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1552780800000",
    "number": "1770042012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 RIDGE ST STE 201",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034643",
            "telephone_number": "712-322-5565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 RIDGE ST STE 201",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515034643",
            "telephone_number": "712-322-5565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VOGT",
        "first_name": "DALLAS",
        "middle_name": "JOHN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-17",
        "last_updated": "2019-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IA",
            "license": "D154087",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Council Bluffs, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2019; 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.