NPIMap

Individual provider Active NPI

Roland Reese Daigle, CRNA

  • Certified Registered Nurse Anesthetist
  • Crockett, TX
National Provider Identifier
1891798781
Registry record updated Mar 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
512552 Issued in TX
Practice address
1105 E Goliad Ave
Crockett, TX 75835-2230
Phone
(936) 544-4996
Fax
(936) 544-4244
NPI assigned
May 24, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2009

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 512552 TX Primary

Addresses

Primary practice location

1105 E Goliad Ave
Crockett, TX 75835-2230

Mailing address

1105 E Goliad Ave
Crockett, TX 75835-2230
Phone (936) 544-4996

Other identifiers 5

IdentifierTypeStateIssuer
84893UOtherTXBCBSTX
88726UOtherTXBCBS
137813514MedicaidTX
137813512MedicaidTX
137813519MedicaidTX

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)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
18382TXMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Dreamworks Anesthesia Associates PLLC Nurse Anesthetist, Certified Registered Past Accepting new patients
The South County Anesthesia Association, PA Past Accepting new patients
Memorial Medical Center of East Texas Past Accepting new patients
Texas Anesthesia Partners Nurse Anesthetist, Certified Registered PastSince Aug 14, 2022 Accepting new patients
Thomas Arthur Halling Past Accepting new patients
Clinical Partners PA Nurse Anesthetist, Certified Registered Past Accepting new patients
Memorial Hospital of Polk County PastSince Jan 1, 2002 Accepting new patients

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1237507200000",
    "number": "1891798781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1105 E GOLIAD AVE",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758352230",
            "telephone_number": "936-544-4996",
            "fax_number": "936-544-4244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1105 E GOLIAD AVE",
            "city": "CROCKETT",
            "state": "TX",
            "postal_code": "758352230",
            "telephone_number": "936-544-4996",
            "fax_number": "936-544-4244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAIGLE",
        "first_name": "ROLAND",
        "middle_name": "REESE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2009-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "512552",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSTX",
            "identifier": "84893U",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "88726U",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137813514",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137813512",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "137813519",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crockett, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2009; 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.