Individual provider Active NPI

Matthew Warner Elledge, CRNA

  • Certified Registered Nurse Anesthetist
  • Roanoke, VA
National Provider Identifier
1922678820
Registry record updated Nov 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
0024191721 Issued in VA
Practice address
1906 Belleview Ave SE Ste a
Roanoke, VA 24014-1838
Phone
(540) 981-7000
NPI assigned
Jul 1, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Critical Care Medicine Registered Nurse 163WC0200X 286339 NC
Certified Registered Nurse Anesthetist 367500000X 7204 NC
Certified Registered Nurse Anesthetist 367500000X 0024191721 VA Primary

Addresses

Primary practice location

1906 Belleview Ave SE Ste a
Roanoke, VA 24014-1838

Mailing address

213 S Jefferson St Ste 1006
Roanoke, VA 24011-1713
Phone (540) 224-5353

Other practice location 1

11 Vanderbilt Park Dr
Asheville, NC 28803-1700
Phone (828) 213-1740

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250102000931 VA Practitioner - Certified Registered Nurse Anesthetist (Crna) 6103287073 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Carilion Professional Services LLCGroup PAC ID 2163323999, 86 clinicians

Practice addresses (Care Compare)

1 Health Cir
Lexington, VA 24450-2448
Phone (540) 458-3300

101 Elm Ave SE
Roanoke, VA 24013-2222
Phone (540) 985-8000

180 Floyd Ave
Rocky Mount, VA 24151-1318
Phone (540) 489-6353

1906 Belleview Ave SE
Roanoke, VA 24014-1838
Phone (540) 853-0222

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7204NCMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Carilion Professional Services LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 6, 2025 Accepting new patients
Carilion Emergency Services, Inc. CurrentSince Dec 26, 2024 Accepting new patients

Locations

434 Peppers Fry Rd NW
Christiansburg, VA 24073
Phone (540) 382-6000

1906 Belleview Ave SE
Ste A
Roanoke, VA 24014

213 S Jefferson St
Ste 1006
Roanoke, VA 24011
Phone (540) 224-5353

180 Floyd Ave
Rocky Mount, VA 24151
Phone (540) 483-5277

Organizations & group practices 2

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 2

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": "1625097600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730678400000",
    "number": "1922678820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "213 S JEFFERSON ST STE 1006",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240111713",
            "telephone_number": "540-224-5353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1906 BELLEVIEW AVE SE STE A",
            "city": "ROANOKE",
            "state": "VA",
            "postal_code": "240141838",
            "telephone_number": "540-981-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "11 Vanderbilt Park Dr",
            "address_purpose": "LOCATION",
            "city": "Asheville",
            "state": "NC",
            "postal_code": "288031700",
            "country_code": "US",
            "telephone_number": "828-213-1740",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ELLEDGE",
        "first_name": "MATTHEW",
        "middle_name": "WARNER",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-01",
        "last_updated": "2024-11-04",
        "certification_date": "2024-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WC0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Critical Care Medicine",
            "state": "NC",
            "license": "286339",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "7204",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0024191721",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roanoke, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2024; 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.