Individual provider Active NPI

Gerald Pedersen, C.R.N.A.

  • Certified Registered Nurse Anesthetist
  • Zachary, LA
National Provider Identifier
1093758716
Registry record updated May 19, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
44332 Issued in LA
Practice address
6300 Main St
Zachary, LA 70791-4037
Phone
(225) 658-4000
NPI assigned
Jun 13, 2006
Last updated
May 19, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 19, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 23775 SC
Certified Registered Nurse Anesthetist 367500000X 44332 LA Primary

Addresses

Primary practice location

6300 Main St
Zachary, LA 70791-4037

Mailing address

3617 Hyacinth Ave
Baton Rouge, LA 70808-2933
Phone (225) 389-2928

Other practice location 1

2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733
Phone (843) 402-1436

Other identifiers 1

IdentifierTypeStateIssuer
AN3110MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA, GA, SC3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20050705000849 LA Practitioner - Certified Registered Nurse Anesthetist (Crna) 3577509140 Reassigns benefits to 4 organizations
I20190114000134 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 3577509140 Reassigns benefits to 1 organization
I20200526002774 SC Practitioner - Certified Registered Nurse Anesthetist (Crna) 3577509140 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Nuedge Anesthesia LLCGroup PAC ID 7911340575, 12 clinicians
Dpi of Louisiana LLCGroup PAC ID 1456886365, 72 clinicians
Dpi of Georgia LLCGroup PAC ID 0941546923, 30 clinicians

Practice addresses (Care Compare)

10105 Park Rowe Cir
Baton Rouge, LA 70810-1688
Phone (225) 906-4843

17000 Medical Ctr Dr
Baton Rouge, LA 70816-3246
Phone (225) 752-2470

300 Colonial Ctr Pkwy
Suite 100N
Roswell, GA 30076-4892
Phone (225) 923-0030

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
44332LAMDCertified Registered Nurse Anesthetist
23775SCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Dpi of Louisiana LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2025 Accepting new patients
Dpi of Georgia, LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 2, 2018 Accepting new patients
Dpi Pain Management LLC Current Accepting new patients
Nuedge Anesthesia LLC CurrentSince Jan 1, 2024 Accepting new patients
Diversified Professionals, Inc. CurrentSince Jul 1, 2010 Accepting new patients
Hospital Service District No. 1 of Iberia Parish CurrentSince Jun 5, 2014 Accepting new patients
Bon Secours St. Francis Xavier Hospital, Inc. Nurse Anesthetist, Certified Registered CurrentSince Aug 18, 2020 Accepting new patients
Hospital Service District No 1 of Iberia Parish CurrentSince Jun 5, 2014 Accepting new patients
The Capital City Anesthesia Group, LLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Dpi of Alabama LLC Nurse Anesthetist, Certified Registered PastSince Jan 4, 2021 Accepting new patients

Locations

960 Joe Frank Harris Pkwy SE
Cartersville, GA 30120
Phone (404) 554-2196

11 Upper Riverdale Rd SW
Riverdale, GA 30274
Phone (770) 897-7277

300 Colonial Center Pkwy
Ste 100N
Roswell, GA 30076
Phone (704) 684-7609

10105 Park Rowe Cir
Baton Rouge, LA 70810
Phone (225) 763-9900

17000 Medical Center Dr
Baton Rouge, LA 70816
Phone (225) 752-2470

5222 Brittany Dr
Baton Rouge, LA 70808
Phone (225) 215-3443

7145 Perkins Rd
Baton Rouge, LA 70808
Phone (225) 765-3111

7301 Hennessy Blvd
#100
Baton Rouge, LA 70808
Phone (225) 215-3443

7301 Hennessy Blvd
Ste 100
Baton Rouge, LA 70808
Phone (225) 763-6011

7310 Perkins Rd
Baton Rouge, LA 70808
Phone (225) 236-3100

7777 Hennessy Blvd
Ste 301
Baton Rouge, LA 70808
Phone (225) 214-6436

8946 Interline Ave
Ste C
Baton Rouge, LA 70809
Phone (225) 529-1143

2315 E Main St
New Iberia, LA 70560
Phone (337) 364-0441

4845 Main St
#A
Zachary, LA 70791
Phone (225) 306-0100

6300 Main St
Zachary, LA 70791
Phone (225) 570-2618

6550 Main St
Ste 2600
Zachary, LA 70791
Phone (225) 570-6357

2095 Henry Tecklenburg Dr
Charleston, SC 29414
Phone (843) 402-1037

Organizations & group practices 11

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": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1716076800000",
    "number": "1093758716",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3617 HYACINTH AVE",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708082933",
            "telephone_number": "225-389-2928",
            "fax_number": "225-389-2931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 MAIN ST",
            "city": "ZACHARY",
            "state": "LA",
            "postal_code": "707914037",
            "telephone_number": "225-658-4000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2095 Henry Tecklenburg Dr",
            "address_purpose": "LOCATION",
            "city": "Charleston",
            "state": "SC",
            "postal_code": "294145733",
            "country_code": "US",
            "telephone_number": "843-402-1436",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PEDERSEN",
        "first_name": "GERALD",
        "name_prefix": "Mr.",
        "credential": "C.R.N.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2024-05-19",
        "certification_date": "2024-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SC",
            "license": "23775",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "LA",
            "license": "44332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AN3110",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Zachary, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2024; 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.