Individual provider Active NPI

Clinton Alan Berry, CRNA

  • Certified Registered Nurse Anesthetist
National Provider Identifier
1124276787
Registry record updated Dec 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
ARNP9272095 Issued in FL
Practice address
Unit 33100
Apo, AE 09180-3100
Phone
(314) 590-0001
NPI assigned
Sep 8, 2008
Last updated
Dec 27, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 27, 2023

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 ARNP9272095 FL Primary

Addresses

Primary practice location

Unit 33100
Apo, AE 09180-3100

Mailing address

Unit 33100
Apo, AE 09180-3100

Other identifiers 3

IdentifierTypeStateIssuer
000373200MedicaidFL
592-03533OtherALBLUE CROSS BLUE SHIELD
G4623OtherFLBLUE CROSS BLUE SHIELD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081009000824 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 4284702721 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
JC Edwards School of Medicine, Marshall University, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ams Baptist LLCGroup PAC ID 6901099688, 80 clinicians

Practice addresses (Care Compare)

123 Baptist Way
Pensacola, FL 32503-2254
Phone (448) 227-8478

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ARNP9272095FLMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Ams Baptist LLC Nurse Anesthetist, Certified Registered CurrentSince Sep 28, 2011 Accepting new patients
Ams of Gulf Breeze LLC Nurse Anesthetist, Certified Registered CurrentSince Feb 1, 2012 Accepting new patients

Locations

123 Baptist Way
Pensacola, FL 32503
Phone (850) 434-4011

1110 Gulf Breeze Pkwy
Pensacola Beach, FL 32561
Phone (850) 438-1848

Organizations & group practices 2

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 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": "1220832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703635200000",
    "number": "1124276787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "UNIT 33100",
            "city": "APO",
            "state": "AE",
            "postal_code": "091803100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "MIL",
            "address_1": "UNIT 33100",
            "city": "APO",
            "state": "AE",
            "postal_code": "091803100",
            "telephone_number": "314-590-0001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRY",
        "first_name": "CLINTON",
        "middle_name": "ALAN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-09-08",
        "last_updated": "2023-12-27",
        "certification_date": "2023-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "ARNP9272095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000373200",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "592-03533",
            "state": "AL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "G4623",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Sources for this page

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

Verify at the official NPI Registry.