Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Wallace Adam Goforth, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1497295901

Wallace Adam Goforth, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in Carbondale, Illinois. Qualified in 2017, 9 years ago. Practices with U S Anesthesia Partners of Texas, PA, a 2,747-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Illinois, New York and Texas.

Years since qualifying
9
Licensed in
IL, NY, TX
In the registry since
2017
Specialties on file
4
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

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Practice location Address checks out

405 W Jackson St
Carbondale, IL 62901-1462
Phone: (618) 549-0721
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 12222 Merit Dr Ste 600, Dallas, TX 75251-3294 — (972) 715-5000

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 1113831 (TX)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence 209016165 (IL)
Registered Nurse Taxonomy 163W00000X · Licence 041.449328 (IL)
Certified Registered Nurse Anesthetist Taxonomy 367500000X · Licence 857695 (NY)

Record details

NPI number1497295901
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNA
Sole proprietorNo
NPI enumeratedMarch 2, 2017
Last updated in NPPESOctober 9, 2025
Certification dateOctober 9, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2017 (9 years in practice)
Group practice U S Anesthesia Partners Of Texas, Pa — 2747 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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