CHRISTOPHER R DOUGHERTY AA NPI 1720336548

NPI Information

  • NPI: 1720336548
  • Provider Name: CHRISTOPHER R DOUGHERTY, AA
  • Classification: Anesthesiologist Assistant - 367H00000X
  • Entity Type: Individual
  • Address: 11141 PARKVIEW PLAZA DR STE 200
    FORT WAYNE, IN
    ZIP 46845
  • Phone: (260) 425-6030

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NPI Details

Christopher R Dougherty, AA is an anesthesiologist assistant in Fort Wayne, IN with 14 years of experience. The provider is an individual certified by the state to perform anesthesia services under the direct supervision of an anesthesiologist. Anesthesiologist Assistants are required to have a bachelor's degree with a premed curriculum prior to entering a two-year anesthesiology assistant program, which is focused upon the delivery and maintenance of anesthesia care as well as advanced patient monitoring techniques. An Anesthesiologist Assistant must work as a member of the anesthesia care team under the direction of a qualified Anesthesiologist. Christopher R Dougherty, AA NPI is 1720336548. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: EMORY UNIVERSITY SCHOOL OF MEDICINE
Graduation Year:2012

The provider's business location address is:

11141 PARKVIEW PLAZA DR STE 200
FORT WAYNE, IN
ZIP 46845-714
Phone: (260) 425-6030
Fax: (260) 425-6028

The following top HCPCS codes were publicly reported for this provider under the Medicare program for the year 2016. The reported codes are based on the top codes for each available Medicare specialty, excluding evaluation and management codes.

  • Anesthesia for other procedure on esophagus, stomach, or upper small bowel using an endoscope (HCPCS:00731)
  • Anesthesia for other procedure on large bowel using an endoscope (HCPCS:00811)

The enumeration date for this NPI number is 8/28/2012 and was last updated on 7/15/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1367H00000XAnesthesiologist Assistant2012029911MISSOURINo
2367H00000XAnesthesiologist Assistant75000180AINDIANAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1431560263OTHERMISSOURITRICARE
2P01129104OTHERMISSOURIRR MCR
31720336548MEDICAIDMISSOURI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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