Individual provider Active NPI

Matthew Mark Conrad, CRNA

  • Certified Registered Nurse Anesthetist
  • Knoxville, TN
National Provider Identifier
1043693310
Registry record updated Nov 23, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
20291 Issued in TN
Practice address
9352 Park West Blvd
Knoxville, TN 37923-4325
Phone
(865) 546-8040
Fax
(865) 541-2787
NPI assigned
Jul 6, 2015
Last updated
Nov 23, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 23, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 20291 TN Primary

Addresses

Primary practice location

9352 Park West Blvd
Knoxville, TN 37923-4325

Mailing address

501 20TH St
Suite 606
Knoxville, TN 37916-1809
Phone (865) 546-8040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160209001135 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 7517261704 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Covenant Anesthesia Group PCGroup PAC ID 6901795830, 231 clinicians

Practice addresses (Care Compare)

1901 Clinch Ave
Knoxville, TN 37916-2307
Phone (865) 331-1111

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
20291TNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of Tennessee, P.C. CurrentSince Dec 22, 2015 Accepting new patients
Covenant Anesthesia Group, PC CurrentSince Aug 23, 2023 Accepting new patients
American Anesthesiology of Tennessee, P.C. Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

1901 Clinch Ave
Knoxville, TN 37916
Phone (865) 331-1111

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

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

9352 Park West Blvd
Knoxville, TN 37923
Phone (865) 373-1000

Dept 888089
Knoxville, TN 37995

990 Oak Ridge Tpke
Oak Ridge, TN 37830
Phone (865) 481-1000

Organizations & group practices 3

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

Hospital & facility affiliations 1

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": "1436140800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1448236800000",
    "number": "1043693310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 20TH ST",
            "address_2": "SUITE 606",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379161809",
            "telephone_number": "865-546-8040",
            "fax_number": "865-541-2787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9352 PARK WEST BLVD",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379234325",
            "telephone_number": "865-546-8040",
            "fax_number": "865-541-2787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONRAD",
        "first_name": "MATTHEW",
        "middle_name": "MARK",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-07-06",
        "last_updated": "2015-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "20291",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2015; 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.