Individual provider Active NPI

Jacob Johnson, CRNA

  • Certified Registered Nurse Anesthetist
  • Asheville, NC
National Provider Identifier
1083158554
Registry record updated Dec 27, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
5576 Issued in NC
Practice address
7105 Davis Grey Dr
Asheville, NC 28803-0208
Phone
(662) 415-6574
NPI assigned
Dec 18, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2016

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 5576 NC Primary

Addresses

Primary practice location

7105 Davis Grey Dr
Asheville, NC 28803-0208

Mailing address

50 Schenck Pkwy
Asheville, NC 28803-3499
Phone (828) 681-1527

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, TN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20211207002075 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 6901188770 Reassigns benefits to 1 organization
I20230424002819 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 6901188770 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifelinc Anesthesia PLLCGroup PAC ID 0941347447, 169 clinicians

Practice addresses (Care Compare)

611 Alcorn Dr
Corinth, MS 38834-9321
Phone (662) 293-1000

935 Wayne Rd
Savannah, TN 38372-1904
Phone (731) 926-8000

Hospital & facility affiliations

  • Magnolia Regional Health Center Hospital, Corinth, MS, CCN 250009

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
901748MSMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Lifelinc Anesthesia, PLLC Nurse Anesthetist, Certified Registered CurrentSince Nov 30, 2021 Accepting new patients

Locations

634 Leigh Dr
Columbus, MS 39705
Phone (601) 978-3393

611 Alcorn Dr
Corinth, MS 38834
Phone (601) 286-6961

499 Azalea Dr
Oxford, MS 38655
Phone (662) 234-7979

2200 Union Ave
Memphis, TN 38104
Phone (901) 274-5813

3340 Players Club Pkwy
Ste 350
Memphis, TN 38125
Phone (901) 207-2017

935 Wayne Rd
Savannah, TN 38372
Phone (731) 925-4954

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.

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": "1482019200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482796800000",
    "number": "1083158554",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "50 SCHENCK PKWY",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "288033499",
            "telephone_number": "828-681-1527"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7105 DAVIS GREY DR",
            "city": "ASHEVILLE",
            "state": "NC",
            "postal_code": "288030208",
            "telephone_number": "662-415-6574"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "JACOB",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-12-18",
        "last_updated": "2016-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "5576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Asheville, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2016; 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.