Individual provider Active NPI

Benjamin Ryan Davis, CRNA, RN

  • Certified Registered Nurse Anesthetist
  • Bowling Green, KY
National Provider Identifier
1043986961
Registry record updated Feb 8, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
147150 Issued in KY
Practice address
250 Park St
Bowling Green, KY 42101-1795
Phone
(270) 745-1000
NPI assigned
Aug 19, 2021
Last updated
Feb 8, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 0000228440 TN
Certified Registered Nurse Anesthetist 367500000X 147150 KY Primary

Addresses

Primary practice location

250 Park St
Bowling Green, KY 42101-1795

Mailing address

551 Collier LN
Gallatin, TN 37066-8262
Phone (615) 478-5141

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240313000653 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 3678919669 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

250 Park St
Bowling Green, KY 42101-1760
Phone (270) 745-1111

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0000228440TNMDRegistered Nurse
147150KYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Commonwealth Health Corporation, Inc. CurrentSince Feb 13, 2024 Accepting new patients
Commonwealth Health Corporation, Inc Current Accepting new patients
Commonwealth Health Corporation, Inc. CurrentSince Feb 13, 2024 Accepting new patients

Locations

350 Park St
Ste 203
Bowling Green, KY 42101
Phone (270) 781-0075

250 Park St
Bowling Green, KY 42101
Phone (270) 745-1000

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": "1629331200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707350400000",
    "number": "1043986961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "551 COLLIER LN",
            "city": "GALLATIN",
            "state": "TN",
            "postal_code": "370668262",
            "telephone_number": "615-478-5141"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 PARK ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421011795",
            "telephone_number": "270-745-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "BENJAMIN",
        "middle_name": "RYAN",
        "credential": "CRNA, RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-08-19",
        "last_updated": "2024-02-08",
        "certification_date": "2024-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "0000228440",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "147150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2024; 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.