Individual provider Active NPI

Brian Dale, CRNA

  • Certified Registered Nurse Anesthetist
  • Knoxville, TN
National Provider Identifier
1063453355
Registry record updated Jun 25, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
10503 Issued in TN
Practice address
501 20TH St
Suite 606
Knoxville, TN 37916-1809
Phone
(865) 546-8040
Fax
(865) 541-2787
NPI assigned
Jun 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2010

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 10503 TN Primary

Addresses

Primary practice location

501 20TH St
Suite 606
Knoxville, TN 37916-1809

Mailing address

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

Other identifiers 5

IdentifierTypeStateIssuer
100035331OtherTNPHP TENNCARE
4014304OtherTNBLUE CROSS
3628373MedicaidTN
4014304OtherTNBLUECARE
430066767OtherTNMEDICARE TRAVELERS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100909000216 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 1557486909 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1997
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

  • Fort Sanders Regional Medical Center Hospital, Knoxville, TN, CCN 440125

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of Tennessee, P.C. CurrentSince Nov 3, 2001 Accepting new patients
American Anesthesiology of Tennessee, P.C. Nurse Anesthetist, Certified Registered CurrentSince Nov 3, 2001 Accepting new patients
Covenant Anesthesia Group, PC CurrentSince Aug 23, 2023 Accepting new patients

Locations

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

Dept 888089
Knoxville, TN 37995

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

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

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

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 and National Provider Directory roles.

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": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277424000000",
    "number": "1063453355",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DALE",
        "first_name": "BRIAN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2010-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "10503",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP TENNCARE",
            "identifier": "100035331",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "4014304",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3628373",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECARE",
            "identifier": "4014304",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE TRAVELERS",
            "identifier": "430066767",
            "state": "TN"
        }
    ],
    "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 Jun 25, 2010; 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.