Roger A Southall, Jr, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

18138 Issued in SC

Practice address

9263 Medical Plaza Dr
Ste E
Charleston, SC 29406-7112

Phone

(843) 572-1228

Fax

(877) 561-7564

NPI assigned

Oct 30, 2012

Last updated

Jan 29, 2013By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

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.

• Mobile Anesthesia, LLC

  • Anesthesiology Physician
  • Charleston, SC
  • NPI 1992943484
  NPD (past)

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

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359417600000",
    "number": "1871847814",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9263 MEDICAL PLAZA DR",
            "address_2": "STE E",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294067112",
            "telephone_number": "843-572-1228",
            "fax_number": "877-561-7564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9263 MEDICAL PLAZA DR",
            "address_2": "STE E",
            "city": "CHARLESTON",
            "state": "SC",
            "postal_code": "294067112",
            "telephone_number": "843-572-1228",
            "fax_number": "877-561-7564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SOUTHALL, JR",
        "first_name": "ROGER",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-10-30",
        "last_updated": "2013-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SC",
            "license": "18138",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "FL",
            "license": "9302221",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• South Carolina Interventional Pain - C, LLC
• South Carolina Medical Specialists PC
• South Carolina Mentor
• South Carolina Neuro, LLC
• South Carolina Women's Center, LLC
• Colton Southard-Goebel, MD
• Bailey Southard, PHARMD
• Kinsey Knight Southard, PA-C
• Molly Mae Southard, RN
• Southeast Cardiology

• Certified Registered Nurse Anesthetist in Charleston, SC
• Providers in Charleston, SC by specialty
• Certified Registered Nurse Anesthetist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2013; 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.