Roger Carl Bryant, C.R.N.A.
Individual provider Active NPI Certified Registered Nurse Anesthetist · Longview, TX
NPI 1851331003 · NPPES record last updated Mar 3, 2009
Key facts
- NPI
- 1851331003
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 604469 (TX)
- Practice address
- 906 Judson Rd
Longview, TX 75601-5113 - Phone
- (903) 655-1313
- Fax
- (903) 657-6067
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Christus Good Shepherd Medical Center
Practice addresses (Care Compare)
700 E Marshall Ave
Longview, TX 75601-5580
Phone (903) 315-2000
Hospital & facility affiliations
- Christus Good Shepherd Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20041122000075 | TX | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 0345205134 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46399 | TX | MD | Certified Registered Nurse Anesthetist |
| 604469 | TX | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christus Good Shepherd Medical Center | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Christus Good Shepherd Medical Center | Current |
Accepting new patients | |
| Anesthesia Consultants | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
Locations
700 E Marshall Ave
Longview, TX 75601
Phone (903) 236-2000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 46399 | TX | |
| Certified Registered Nurse Anesthetist | 367500000X | 604469 | TX | Yes |
Addresses
Primary practice location
906 Judson Rd
Longview, TX 75601-5113
Mailing address
P.O. Box 2527
Longview, TX 75606-2527
Phone (903) 655-1313
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 169620501 | Medicaid | TX |
Other providers in Longview, TX
- Mary Kathryne Brun
- Barry Clinton Bruyere
- Misti Dawn Bryant Bradshaw
- Brandon G Bryant
- Kayla Marie Bryant
- Tonie Elaine Bryant
- Scott G Bryk
- Priyanka Buchupalle
- Buckner Children and Family Services
- Buckner Retirement Services, Inc
All providers in Longview, TX · Certified Registered Nurse Anesthetist in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.