Individual provider Active NPI

Jeannie Glisson, CRNA

  • Certified Registered Nurse Anesthetist
  • New York, NY
National Provider Identifier
1104902717
Registry record updated Dec 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
472709-1 Issued in NY
Practice address
310 E 14TH St
Ny Eye & Ear Infirmary
New York, NY 10003-4201
Phone
(212) 979-4000
Fax
(845) 790-2675
NPI assigned
Oct 27, 2006
Last updated
Dec 16, 2008By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2008

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 472709-1 NY Primary

Addresses

Primary practice location

310 E 14TH St
Ny Eye & Ear Infirmary
New York, NY 10003-4201

Mailing address

2 Catharine St
P O Box 550
Poughkeepsie, NY 12601-3100
Phone (866) 868-8415

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060504000201 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 4284644287 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
472709-1NYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Icahn School of Medicine at Mount Sinai Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2024 Accepting new patients

Locations

310 E 14th St
New York, NY 10003
Phone (212) 979-4000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229385600000",
    "number": "1104902717",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 CATHARINE ST",
            "address_2": "P O BOX 550",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126013100",
            "telephone_number": "866-868-8415",
            "fax_number": "845-790-2675"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "310 E 14TH ST",
            "address_2": "NY EYE & EAR INFIRMARY",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100034201",
            "telephone_number": "212-979-4000",
            "fax_number": "845-790-2675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLISSON",
        "first_name": "JEANNIE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-27",
        "last_updated": "2008-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NY",
            "license": "472709-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.