DAVID DEROSSO (NPI# 1194897710) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1194897710 |
| Entity Type | Individual |
| Full Name | DAVID DEROSSO |
| Credential | CRNA |
| Practice Address |
1499 Fair Rd Statesboro GA 30458-1683 |
| Mailing Address |
598 3rd St Macon GA 31201-3357 |
| Practice Telephone | 7046625544 |
| Mailing Telephone | 4786336706 |
| Mailing Fax Number | 4786335384 |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2013-12-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | RN135847 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | 000932236B | 05 | |
| GA | WELLCARE | 344303 | 01 |
| GA | RAILROAD MEDICARE | P00115347 | 01 |
| GA | PEACHSTATE | 000932236B | 01 |
| Street Address |
1499 FAIR RD |
| City | STATESBORO |
| State | GA |
| Zip Code | 30458-1683 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205839024 | Eric M Chand | Pathology | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2005-05-24 |
| 1174146187 | Trevor Weathersby | Nurse Anesthetist, Certified Registered | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2020-05-26 |
| 1689205593 | Tiara Leonna Bradley | Nurse Practitioner | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2020-01-29 |
| 1619493517 | Cody Robert Ward | Physician Assistant | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2017-08-22 |
| 1316467467 | Stephanie Lindamood | Nurse Practitioner | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2017-06-20 |
| 1386010478 | Wendy Futch | Nurse Practitioner | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2015-08-12 |
| 1134524036 | Tristia Knight | Nurse Practitioner | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2014-11-04 |
| 1871930578 | Jennifer L Roberson | Physical Therapy Assistant | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2013-06-04 |
| 1396182184 | Jenna Raye Bazemore | Physical Therapist | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2013-06-03 |
| 1346687191 | Janet C Shaw | Speech-Language Pathologist | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2013-06-03 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639642218 | Youtherapy | Counselor | 430 Northside Dr East, Suite 160 Mb326, Statesboro, GA 30458 | 2019-01-07 |
| 1053891853 | Alexandria Franklin | Specialist/Technologist | 1332 Southern Dr, Statesboro, GA 30458 | 2018-08-21 |
| 1740780006 | Michael Ryan Clark | Pharmacist | 556 Northside Drive, Statesboro, GA 30458 | 2018-02-13 |
| 1689186405 | Chandler James Herman | Specialist/Technologist | 590 Herty Dr., Statesboro, GA 30458 | 2017-11-02 |
| 1477009181 | Mama Doc Pediatrics, LLC | Pediatrics | 400 East Grady Street, Statesboro, GA 30458 | 2016-09-01 |
| 1053761171 | Rebekah Roessler | Specialist/Technologist | 2687 Akins Blvd, Statesboro, GA 30458 | 2016-06-20 |
| 1427412253 | Refocus Counseling and Consulting Services | Community/Behavioral Health | 4325 Country Club, 4, Statesboro, GA 30458 | 2016-04-07 |
| 1023408523 | Kacy H. Nesmith | Nurse Practitioner | 1098 Bermuda Run, Suite 6, Statesboro, GA 30458 | 2015-02-04 |
| 1760870398 | Jessica Pasternack | Specialist/Technologist | 2687 Akins Boulevard, Statesboro, GA 30458 | 2015-01-06 |
| 1922401629 | Nathan D'amico | Student in an Organized Health Care Education/Training Program | 15 W Grady Street Unit A, Statesboro, GA 30458 | 2014-10-08 |
| Find all providers in zip 30458 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285626663 | Dean P Baynon | Nurse Anesthetist, Certified Registered | 1904 Stuckey Ln, Statesboro, GA 30461-7373 | 2005-08-22 |
| 1437151123 | Steven Ray Hendrix | Nurse Anesthetist, Certified Registered | 106 Proctor St, Statesboro, GA 30458-1351 | 2005-08-11 |
| 1174146187 | Trevor Weathersby | Nurse Anesthetist, Certified Registered | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2020-05-26 |
| 1316346471 | Statesboro Ent Surgical Center | Nurse Anesthetist, Certified Registered | 106 Proctor St, Statesboro, GA 30458-1351 | 2014-08-14 |
| 1407195225 | John Braxton Redding | Nurse Anesthetist, Certified Registered | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2013-02-14 |
| 1558412023 | Statesboro Hma Physician Management LLC | Nurse Anesthetist, Certified Registered | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2007-01-13 |
| 1235203522 | James Robert Stockton | Nurse Anesthetist, Certified Registered | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2006-11-20 |
| 1093887770 | Robert D Counts | Nurse Anesthetist, Certified Registered | 1499 Fair Rd, Statesboro, GA 30459-1048 | 2006-11-15 |
| 1467524660 | Brenda Leigh Tolksdorf | Nurse Anesthetist, Certified Registered | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2006-11-14 |
| 1386739522 | Helen Huffingham | Nurse Anesthetist, Certified Registered | 1499 Fair Rd, Statesboro, GA 30458-1683 | 2006-10-04 |
| Find all providers in STATESBORO | ||||
| City | STATESBORO |
| Zip Code | 30458 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.