Individual provider Active NPI

Detty Thomas Johnson

  • Certified Registered Nurse Anesthetist
  • Apex, NC
National Provider Identifier
1063927549
Registry record updated Dec 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
251930 Issued in NC
Practice address
8505 Newberry Grove Dr
Apex, NC 27539-7970
Phone
(919) 670-7547
NPI assigned
Dec 6, 2017
Last updated
Dec 6, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 6, 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 251930 NC Primary

Addresses

Primary practice location

8505 Newberry Grove Dr
Apex, NC 27539-7970

Mailing address

8505 Newberry Grove Dr
Apex, NC 27539-7970
Phone (919) 670-7547

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190220001830 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 8921346743 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Duke Health Integrated Practice IncGroup PAC ID 8325412737, 3,140 clinicians
East Carolina Anesthesia Associates PLLCGroup PAC ID 5092720813, 691 clinicians

Practice addresses (Care Compare)

120 E Carver St
Durham, NC 27704-2700
Phone (919) 684-8111

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-8114

4420 Lake Boone TRL
Raleigh, NC 27607-7505
Phone (919) 873-9533

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
5992NCMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of North Carolina, PLLC Anesthesiology CurrentSince Oct 22, 2018 Accepting new patients
American Anesthesiology of North Carolina, PLLC Anesthesiology CurrentSince Oct 22, 2018 Accepting new patients
Duke Health Integrated Practice, Inc. CurrentSince Jul 4, 2023 Accepting new patients
East Carolina Anesthesia Associates, PLLC Anesthesiology CurrentSince Oct 30, 2023 Accepting new patients
Providence Anesthesiology Associates, P.a. Anesthesiology CurrentSince Apr 25, 2023 Accepting new patients
Regional Anesthesia, PLLC CurrentSince Feb 13, 2023 Accepting new patients
American Anesthesiology of North Carolina, PLLC Anesthesiology Past Accepting new patients

Locations

131 Providence Rd
Ste 200
Charlotte, NC 28207
Phone 70474958001101

1918 Randolph Rd
Ste 740
Charlotte, NC 28207
Phone (704) 316-0810

120 E Carver St
Durham, NC 27704
Phone (919) 470-1000

2301 Erwin Rd
Durham, NC 27705
Phone (919) 668-0289

3643 N Roxboro St
Durham, NC 27704
Phone (919) 470-6186

40 Duke Medicine Cir
Durham, NC 27710
Phone (919) 681-6588

2430 Emerald Pl
Ste 103
Greenville, NC 27834
Phone (252) 752-2140

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

3100 Spring Forest Rd
Ste 130
Raleigh, NC 27616
Phone (919) 882-0705

3400 Wake Forest Rd
Raleigh, NC 27609
Phone (919) 954-3000

4420 Lake Boone Trl
Raleigh, NC 27607
Phone (919) 784-3034

Organizations & group practices 7

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 7

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": "1512518400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512518400000",
    "number": "1063927549",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8505 NEWBERRY GROVE DR",
            "city": "APEX",
            "state": "NC",
            "postal_code": "275397970",
            "telephone_number": "919-670-7547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8505 NEWBERRY GROVE DR",
            "city": "APEX",
            "state": "NC",
            "postal_code": "275397970",
            "telephone_number": "919-670-7547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DETTY",
        "middle_name": "THOMAS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-12-06",
        "last_updated": "2017-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "251930",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Apex, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 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.