Russell Edward Proffitt, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

18164 Issued in TN

Practice address

1651 Gunbarrel Rd Ste 102
Chattanooga, TN 37421-3289

Phone

(423) 308-0390

Fax

(423) 308-0393

NPI assigned

Jan 9, 2014

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Southeastern Surgical, LLCGroup PAC ID 7911393509, 9 clinicians

Galen Medical Group, PCGroup PAC ID 2668377391, 122 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Galen Medical Group, PC

  • Internal Medicine Physician
  • Hixson, TN
  • NPI 1346250057

  TN

  Medicare reassignment Care Compare group NPD
• Southeastern Surgical, LLC

  • Certified Registered Nurse Anesthetist
  • Chattanooga, TN
  • NPI 1326796426

  Nurse Anesthetist, Certified Registered, TN

  Medicare reassignment Care Compare group NPD
• Amsurg Chattanooga Anesthesia LLC

  • Anesthesiology Physician
  • Chattanooga, TN
  • NPI 1841586922

  TN

  Medicare reassignment NPD
• Wellmont Medical Associates Inc

  • Pulmonary Disease Physician
  • Kingsport, TN
  • NPI 1780986257

  TN

  Medicare reassignment NPD
• Southeastern Surgical, LLC

  • Ambulatory Surgical Clinic/Center
  • Chattanooga, TN
  • NPI 1831766955

  Nurse Anesthetist, Certified Registered

  NPD
• Wellmont Medical Associates, Inc.

  • Internal Medicine Physician
  • Bristol, TN
  • NPI 1558812198
  NPD
• Chattanooga Endoscopy ASC LLC

  • Ambulatory Surgical Clinic/Center
  • Chattanooga, TN
  • NPI 1447223938
  NPD (past)

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

{
    "created_epoch": "1389225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734048000000",
    "number": "1124440128",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4976 ALPHA LN",
            "city": "HIXSON",
            "state": "TN",
            "postal_code": "373435470",
            "telephone_number": "423-497-5355",
            "fax_number": "423-308-0281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1651 GUNBARREL RD STE 102",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374213289",
            "telephone_number": "423-308-0390",
            "fax_number": "423-308-0393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PROFFITT",
        "first_name": "RUSSELL",
        "middle_name": "EDWARD",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-01-09",
        "last_updated": "2024-12-13",
        "certification_date": "2024-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "18164",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Protech Medical LLC

• All providers in Chattanooga, TN
• Certified Registered Nurse Anesthetist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 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.