NPIMap

Organization Active NPI

Stage Two Anesthesia PLLC

  • Certified Registered Nurse Anesthetist
  • Nashville, TN
National Provider Identifier
1063709392
Registry record updated Feb 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
STAGE TWO ANESTHESIA PLLC
Practice address
210 25TH Ave N Ste 920
Nashville, TN 37203-9609
Phone
(888) 209-0305
Fax
(952) 442-3620
NPI assigned
Jul 7, 2011
Last updated
Feb 10, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2020

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

Authorized official

Name
Victor L Martin, CRNANPI 1245206572
Title
Owner / Authorized Official
Phone
(952) 442-9770

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

210 25TH Ave N Ste 920
Nashville, TN 37203-9609

Mailing address

400 East 10TH St
Waconia, MN 55387-4552
Phone (888) 209-0305

Other practice location 1

1059 Neal St Ste B
Cookeville, TN 38501-0947
Phone (888) 209-0305

Other practice location 2

79 Fairfield Blvd
Crossville, TN 38558-4417
Phone (888) 209-0305

Other practice location 3

310 25th Ave N
Suite 105
Nashville, TN 37203-1515
Phone (888) 209-0305

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110726000522 TN Part B Supplier - Clinic/Group Practice 8022286699 Receives reassigned benefits from 26 practitioners
Practice locations: Cookeville, TN; Crossville, TN; Nashville, TN

National Provider Directory

National Provider Directory

Locations

310 25th Ave N
Ste 105
Nashville, TN 37203
Phone (615) 329-9023

3443 Dickerson Pike
Ste 250
Nashville, TN 37207
Phone (615) 860-1040

Practitioners & affiliated clinicians

Practitioners 27

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 27

NPI Registry JSON

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

{
    "created_epoch": "1309996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581292800000",
    "number": "1063709392",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 EAST 10TH ST",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553874552",
            "telephone_number": "888-209-0305",
            "fax_number": "952-442-3620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 25TH AVE N STE 920",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372039609",
            "telephone_number": "888-209-0305",
            "fax_number": "952-442-3620"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1059 Neal St Ste B",
            "address_purpose": "LOCATION",
            "city": "Cookeville",
            "state": "TN",
            "postal_code": "385010947",
            "country_code": "US",
            "telephone_number": "888-209-0305",
            "fax_number": "952-442-3620",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "79 Fairfield Blvd",
            "address_purpose": "LOCATION",
            "city": "Crossville",
            "state": "TN",
            "postal_code": "385584417",
            "country_code": "US",
            "telephone_number": "888-209-0305",
            "fax_number": "952-442-3620",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "310 25th Ave N",
            "address_2": "Suite 105",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372031515",
            "country_code": "US",
            "telephone_number": "888-209-0305",
            "fax_number": "952-442-3620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "STAGE TWO ANESTHESIA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-07",
        "last_updated": "2020-02-10",
        "certification_date": "2020-02-10",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER / AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "952-442-9770",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nashville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.