Individual provider Active NPI

Jennifer D Del Bagno, CRNA

  • Certified Registered Nurse Anesthetist
  • Lawrenceville, GA
National Provider Identifier
1104852755
Registry record updated Apr 4, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN086149 Issued in GA
Practice address
1000 Medical Center Blvd
Lawrenceville, GA 30046-0000
Phone
(770) 277-3056
Fax
(855) 204-5244
NPI assigned
Jun 24, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2014

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 R086149 GA
Certified Registered Nurse Anesthetist 367500000X RN086149 GA Primary

Addresses

Primary practice location

1000 Medical Center Blvd
Lawrenceville, GA 30046-0000

Mailing address

PO Box 551420
Fort Lauderdale, FL 33355-1420
Phone (800) 243-3839

Other identifiers 2

IdentifierTypeStateIssuer
00568917AMedicaidGA
000568917AMedicaidGA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100503000485 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 0547398190 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Atlanta Anesthesia Professionals, LLCGroup PAC ID 5496134348, 543 clinicians

Practice addresses (Care Compare)

1000 Medical Ctr Blvd
Lawrenceville, GA 30046-7694
Phone (678) 312-1000

3620 Howell Ferry Rd
Duluth, GA 30096-3178
Phone (678) 312-6800

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
86.17 of 100Reported as group
Quality
74.86
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R086149GAMDCertified Registered Nurse Anesthetist
RN086149GAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Mulkey Anesthesiology Associates LLC CurrentSince Apr 1, 2023 Accepting new patients
American Anesthesiology Associates of Georgia, LLC CurrentSince May 7, 2013 Accepting new patients
Interventional Spine and Pain Management Ambulatory Surgical Center CurrentSince Apr 1, 2023 Accepting new patients
North Atlanta Professional Services LLC CurrentSince Jan 1, 2021 Accepting new patients
North Atlanta Anesthesia Professionals, LLC CurrentSince May 1, 2022 Accepting new patients
Gwinnett Anesthesia Service PC Past Accepting new patients

Locations

3390 Peachtree Rd NE
Ste 1500
Atlanta, GA 30326
Phone 40492049502501

3870 Medical Park Dr
Ste 100
Austell, GA 30106

3870 Medical Park Dr
Austell, GA 30106
Phone (770) 923-7778

1388 Wellbrook Cir NE
Conyers, GA 30012

1388 Wellbrook Cir NE
#A
Conyers, GA 30012
Phone (770) 385-7985

2701 N Decatur Rd
Decatur, GA 30033
Phone (404) 501-1000

1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356

1000 Johnson Fy Rd NE
Sandy Springs, GA 30342
Phone (404) 851-1000

Organizations & group practices 6

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": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1396569600000",
    "number": "1104852755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 551420",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333551420",
            "telephone_number": "800-243-3839",
            "fax_number": "954-839-2569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 MEDICAL CENTER BLVD",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300460000",
            "telephone_number": "770-277-3056",
            "fax_number": "855-204-5244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEL BAGNO",
        "first_name": "JENNIFER",
        "middle_name": "D",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-24",
        "last_updated": "2014-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "R086149",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN086149",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00568917A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000568917A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2014; 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.