Individual provider Active NPI

Melissa Mary Marin, CRNA

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
National Provider Identifier
1063579563
Registry record updated Aug 3, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
163991 Issued in NC
Practice address
8800 N Tryon St
Charlotte, NC 28262-3300
Phone
(704) 863-6000
NPI assigned
Jan 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2017

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 163991 NC Primary

Addresses

Primary practice location

8800 N Tryon St
Charlotte, NC 28262-3300

Mailing address

4400 Golf Acres Drive Suite a
Charlotte, NC 28208-5906
Phone (704) 512-6428

Other identifiers 2

IdentifierTypeStateIssuer
NAN651MedicaidSC
8052809MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070626000737 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 2163521576 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CHS Anesthesia Services Group IncGroup PAC ID 5799007324, 742 clinicians

Practice addresses (Care Compare)

8800 N Tryon St
Charlotte, NC 28262-3300
Phone (704) 863-6000

Hospital & facility affiliations

  • Atrium Health University City Hospital, Charlotte, NC, CCN 340166

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
163991NCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
The Charlotte Mecklenburg Hospital Authority Nurse Anesthetist, Certified Registered CurrentSince May 1, 2015 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
CHS Anesthesia Services Group Inc CurrentSince Sep 1, 2017 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince May 1, 2015 Accepting new patients

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 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": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1501718400000",
    "number": "1063579563",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4400 GOLF ACRES DRIVE SUITE A",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282085906",
            "telephone_number": "704-512-6428"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8800 N TRYON ST",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282623300",
            "telephone_number": "704-863-6000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARIN",
        "first_name": "MELISSA",
        "middle_name": "MARY",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-03",
        "last_updated": "2017-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "163991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NAN651",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8052809",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2017; 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.