Wallace Adam Goforth, CRNA in Carbondale, IL - Medicare Certified Registered Nurse Anesthetist (crna)

Wallace Adam Goforth, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Carbondale, Illinois. He graduated from nursing school in 2017 and has 8 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). He is a member of the group practice Northstar Anesthesia Iii Pa and his current practice location is 405 W Jackson St, Carbondale, Illinois. You can reach out to his office (for appointments etc.) via phone at (618) 549-0721.

Wallace Adam Goforth is licensed to practice in Texas (license number 1113831) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1497295901.

Contact Information

	Wallace Adam Goforth, CRNA
	405 W Jackson St, Carbondale, IL 62901-1462
	(618) 549-0721
	Not Available

Map and Direction

Provider's Profile

Full Name	Wallace Adam Goforth
Gender	Male
Speciality	Certified Registered Nurse Anesthetist (crna)
Experience	8 Years
Location	405 W Jackson St, Carbondale, Illinois
Accepts Medicare Assignments	Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.

Medical Education and Training:

Wallace Adam Goforth graduated from nursing school in 2017

NPI Data:

NPI Number: 1497295901
Provider Enumeration Date: 03/02/2017
Last Update Date: 10/09/2025

Medicare PECOS Information:

PECOS PAC ID: 3476829995
Enrollment ID: I20230418002463

Medical Identifiers

Medical identifiers for Wallace Adam Goforth such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1497295901	NPI	-	NPPES

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
367500000X	Nurse Anesthetist, Certified Registered	1113831 (Texas)	Primary
367500000X	Nurse Anesthetist, Certified Registered	209016165 (Illinois)	Secondary
163W00000X	Registered Nurse	041.449328 (Illinois)	Secondary
367500000X	Nurse Anesthetist, Certified Registered	857695 (New York)	Secondary

Group Practice Association

Group Practice Name	Group PECOS PAC ID	No. of Members
Northstar Anesthesia Iii Pa	0042630501	347

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Wallace Adam Goforth allows following entities to bill medicare on his behalf.

Entity Name	Northstar Anesthesia Iii Pa
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1356968952 PECOS PAC ID: 0042630501 Enrollment ID: O20201022000080

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Wallace Adam Goforth is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Wallace Adam Goforth, CRNA 35 Albany Rd Ste C, Carbondale, IL 62903-7647 Ph: (618) 457-5111	Wallace Adam Goforth, CRNA 405 W Jackson St, Carbondale, IL 62901-1462 Ph: (618) 549-0721

Reviews and Comments

Nurse Anesthetist, Certified Registered Nurses in Carbondale, IL

Mr. Dan Edward Miller, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 405 W Jackson St, Carbondale, IL 62901 Phone: 618-549-0721
Dr. Nathaniel C Crum, DNP Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 405 W Main St, Carbondale, IL 62901 Phone: 618-549-0721 Fax: 618-529-0449
Mr. Shawn Wayne Pyle, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 405 W Jackson St, Carbondale, IL 62901 Phone: 618-549-0721 Fax: 618-529-0449
Justin D Craft, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 405 W Jackson St, Carbondale, IL 62901 Phone: 618-549-0721
Megan E Sims, DNP, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 405 W Jackson St, Carbondale, IL 62901 Phone: 618-549-0721
Britley Ann White, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 405 W Jackson St, Sih Medical Group Anesthesiology, Carbondale, IL 62901 Phone: 618-549-0721 Fax: 618-529-0529
Ms. Christine Marie Dakin, CRNA Nurse Anesthetist - CR Medicare: Not Enrolled in Medicare Practice Location: 2601 W Main St, Carbondale, IL 62901 Phone: 618-549-5361 Fax: 618-549-5128

Wallace Adam Goforth, CRNA - Medicare Certified Registered Nurse Anesthetist (crna) in Carbondale, IL