American Anesthesiology of Mississippi LLC
Organization Active NPI Anesthesiology Physician · Melville, NY
NPI 1023723558 · NPPES record last updated Sep 16, 2024
Key facts
- NPI
- 1023723558
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anesthesiology Physician 207L00000X
- Legal business name
- AMERICAN ANESTHESIOLOGY OF MISSISSIPPI LLC
- Practice address
- 1305 Walt Whitman Rd Ste 300
Melville, NY 11747-4300 - Phone
- (516) 945-3000
- NPI assigned
- Jan 19, 2023
- Organization subpart
- No
Authorized official
- Name
- Dewayne Boyd
- Title
- Manager
- Phone
- (516) 370-3824
Practitioners 56
-
Warren Jeffrey Anderson, CRNA
-
Jovie N. Bridgewater, M.D.
-
Lashanda Farris, CRNA
-
Erica M Goodrich, CRNA
-
Susan D. Hare, CRNA
-
Vincent Hayes, CRNA
-
Gloria S. Hicks, CRNA
-
Charles C Ingram, MD
-
Holly Jackson, CRNA
-
Darron Johnson, CRNA
-
Madison McCaskill, CRNA
-
Dennis Dewayne McCoy, M.D
-
Valerie Antrese Murry, CRNA
-
Edward Lee Phelps, CRNA
-
Brittany Pickens, CRNA
-
Jonathan Wesley Reed, CRNA
-
Nikkita Shanee Robinson, CRNA
-
Janie Parrott Thompson, CRNA
-
John Walker, CRNA
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20230311000163 | MS | Part B Supplier - Clinic/Group Practice | 4789057878 |
Receives reassigned benefits from 50 practitioners Practice locations: Southaven, MS |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician |
207L00000X | Yes |
Addresses
Primary practice location
1305 Walt Whitman Rd Ste 300
Melville, NY 11747-4300
Mailing address
1305 Walt Whitman Rd Ste 300
Melville, NY 11747-4300
Phone (516) 945-3000
NPI Registry JSON
{
"created_epoch": "1674086400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1726444800000",
"number": "1023723558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1305 WALT WHITMAN RD STE 300",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117474300",
"telephone_number": "516-945-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1305 WALT WHITMAN RD STE 300",
"city": "MELVILLE",
"state": "NY",
"postal_code": "117474300",
"telephone_number": "516-945-3000"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AMERICAN ANESTHESIOLOGY OF MISSISSIPPI LLC",
"organizational_subpart": "NO",
"enumeration_date": "2023-01-19",
"last_updated": "2024-09-16",
"certification_date": "2024-09-16",
"status": "A",
"authorized_official_last_name": "BOYD",
"authorized_official_first_name": "DEWAYNE",
"authorized_official_title_or_position": "MANAGER",
"authorized_official_telephone_number": "516-370-3824"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Anesthesiology",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Melville, NY
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- American Anesthesiology of Florida, Inc
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- Yoram Amiran
- Victor Amuzie
- Antonia Anagnostopoulos
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All providers in Melville, NY · Anesthesiology Physician in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 16, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.