Individual provider Active NPI

Denise C. Roof, CRNA

  • Certified Registered Nurse Anesthetist
  • Paducah, KY
National Provider Identifier
1962596742
Registry record updated Jul 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3003942 Issued in KY
Practice address
225 Medical Center Dr
Suite 308
Paducah, KY 42003-7914
Phone
(270) 441-4750
Fax
(270) 441-4770
NPI assigned
Oct 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2013

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 3003942 KY Primary

Addresses

Primary practice location

225 Medical Center Dr
Suite 308
Paducah, KY 42003-7914

Mailing address

225 Medical Center Dr
Suite 308
Paducah, KY 42003-7914
Phone (270) 441-4750

Other identifiers 3

IdentifierTypeStateIssuer
74006040MedicaidKY
P00279351OtherRAILROAD MEDICARE
000000361142OtherBCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140619001298 IN Practitioner - Certified Registered Nurse Anesthetist (Crna) 7214902071 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3003942KYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Dynamics LLC Nurse Anesthetist, Certified Registered CurrentSince Apr 25, 2020 Accepting new patients
Anesthesia Care Associates, LLC Nurse Anesthetist, Certified Registered CurrentSince May 28, 2014 Accepting new patients
Digestive Care of Evansville PC Past Accepting new patients

Locations

4411 Washington Ave
Ste 100
Evansville, IN 47714
Phone (313) 637-9861

801 Saint Marys Dr
Ste 205
Evansville, IN 47714
Phone (812) 477-6103

801 Saint Marys Dr
Ste 205W
Evansville, IN 47714
Phone (812) 477-6103

647 2nd St
Ste A
Jasper, IN 47546
Phone (812) 477-6103

Organizations & group practices 3

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": "1159833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1373932800000",
    "number": "1962596742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 MEDICAL CENTER DR",
            "address_2": "SUITE 308",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420037914",
            "telephone_number": "270-441-4750",
            "fax_number": "270-441-4770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 MEDICAL CENTER DR",
            "address_2": "SUITE 308",
            "city": "PADUCAH",
            "state": "KY",
            "postal_code": "420037914",
            "telephone_number": "270-441-4750",
            "fax_number": "270-441-4770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROOF",
        "first_name": "DENISE",
        "middle_name": "C.",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-03",
        "last_updated": "2013-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3003942",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74006040",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00279351",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000361142",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Paducah, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.