Individual provider Active NPI

Jennifer L Jackson, CRNA

  • Certified Registered Nurse Anesthetist
  • Chattanooga, TN
National Provider Identifier
1043561608
Registry record updated Feb 7, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
APN16918 Issued in TN
Practice address
2341 McCallie Ave
Suite 402
Chattanooga, TN 37404-3239
Phone
(423) 698-3309
Fax
(423) 624-6355
NPI assigned
Sep 24, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X APN16918 TN Primary
Certified Registered Nurse Anesthetist 367500000X RN147906 TN

Addresses

Primary practice location

2341 McCallie Ave
Suite 402
Chattanooga, TN 37404-3239

Mailing address

PO Box 3549
Chattanooga, TN 37404-0549
Phone (423) 698-3309

Other identifiers 3

IdentifierTypeStateIssuer
4335469OtherTNBC BS OF TN
1530475MedicaidTN
P01124805OtherRAILROAD MEDICARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20121011000922 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 9032368733 Reassigns benefits to 1 organization
I20200911000187 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 9032368733 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Georgia Anesthesia Services PCGroup PAC ID 2769800515, 44 clinicians

Practice addresses (Care Compare)

1200 Memorial Dr
Dalton, GA 30720-2529
Phone (706) 272-6000

Hospital & facility affiliations

  • Hamilton Medical Center Hospital, Dalton, GA, CCN 110001

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
APN16918TNMDCertified Registered Nurse Anesthetist
RN147906TNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of Tennessee, P.C. Current Accepting new patients
North Georgia Anesthesia Services PC CurrentSince Sep 1, 2020 Accepting new patients
Anesthesiologists Associated PC Nurse Anesthetist, Certified Registered Past Accepting new patients
Anesthesiologists Associated PC Past Accepting new patients

Locations

1200 Memorial Dr
Dalton, GA 30720
Phone (706) 272-6115

2525 Desales Ave
Chattanooga, TN 37404
Phone (423) 495-2620

2515 Desales Ave
Chattanooga, TN 37404
Phone (423) 648-6672

2333 McCallie Ave
Chattanooga, TN 37404
Phone (423) 493-1387

9300 Park West Blvd
Knoxville, TN 37923
Phone (865) 427-4040

501 20th St
Ste 606
Knoxville, TN 37916
Phone (865) 331-2278

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1348444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1360195200000",
    "number": "1043561608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3549",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374040549",
            "telephone_number": "423-698-3309",
            "fax_number": "423-624-6355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2341 MCCALLIE AVE",
            "address_2": "SUITE 402",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374043239",
            "telephone_number": "423-698-3309",
            "fax_number": "423-624-6355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON",
        "first_name": "JENNIFER",
        "middle_name": "L",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-09-24",
        "last_updated": "2013-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "APN16918",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "RN147906",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS OF TN",
            "identifier": "4335469",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1530475",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P01124805",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.