Active NPI
Devin Michael Tully
- Certified Registered Nurse Anesthetist
- Fort Myers, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 73722
- Practice address
- 10501 Fgcu Blvd S
Fort Myers, FL 33965-9079 - Phone
- (904) 589-5030
- NPI assigned
- Nov 21, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 9443736 | FL | |
| Certified Registered Nurse Anesthetist | 367500000X | 73722 | NM | Primary |
| Student in an Organized Health Care Education/Training Program | 390200000X |
Addresses
Primary practice location
10501 Fgcu Blvd S
Fort Myers, FL 33965-9079
Mailing address
10501 Fgcu Blvd S
Fort Myers, FL 33965-9079
Phone (904) 589-5030
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NM
Enrollment records 1
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)
2400 Unser Blvd SE
Suite 9100B
Rio Rancho, NM 87124-4740
Phone (720) 245-0321
Hospital & facility affiliations
- Presbyterian Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 9443736 | FL | MD | Registered Nurse |
| 73722 | NM | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Main Street Anesthesia of New Mexico, LLC | Multi-Specialty | Current | Accepting new patients |
Locations
2400 Unser Blvd SE
Ste 9100B
Rio Rancho, NM 87124
Phone (505) 926-1400
117 E 19th St
Roswell, NM 88201
Phone (505) 727-2000
Organizations & group practices 1
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.
-
- Anesthesiology Physician
- Albuquerque, NM
- NPI 1275010985
Multi-Specialty
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Albuquerque, NM
- NPI 1215913470
-
- Psychiatric Hospital Unit
- Albuquerque, NM
- NPI 1598740482
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668988800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702857600000",
"number": "1073222949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10501 FGCU BLVD S",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339659079",
"telephone_number": "904-589-5030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10501 FGCU BLVD S",
"city": "FORT MYERS",
"state": "FL",
"postal_code": "339659079",
"telephone_number": "904-589-5030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TULLY",
"first_name": "DEVIN",
"middle_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-11-21",
"last_updated": "2023-12-18",
"certification_date": "2023-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Registered Nurse",
"state": "FL",
"license": "9443736",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "NM",
"license": "73722",
"primary": true
},
{
"code": "390200000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Fort Myers, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2023; 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.