Active NPI
Mason Pham
- Certified Registered Nurse Anesthetist
- Harrogate, TN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 4050471
- Practice address
- 6965 Cumberland Gap Pkwy
Harrogate, TN 37752-8231 - Phone
- (423) 869-3611
- NPI assigned
- Jun 20, 2023
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 4050471 | KY | Primary |
Addresses
Primary practice location
6965 Cumberland Gap Pkwy
Harrogate, TN 37752-8231
Mailing address
2017 Vail Dr
Garland, TX 75044-6790
Phone (468) 888-3048
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in KY
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1 Saint Joseph Dr
Lexington, KY 40504-3742
Phone (859) 313-1515
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4050471 | KY | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Commonwealth Anesthesia, PSC | Single Specialty | Current | Accepting new patients |
Locations
1 Saint Joseph Dr
Lexington, KY 40504
Phone (502) 350-5000
310 S Limestone
Lexington, KY 40508
Phone (606) 252-6612
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 and National Provider Directory roles.
Hospital & facility affiliations 3
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Lexington, KY
- NPI 1437150984
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1687219200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1766102400000",
"number": "1144905886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2017 VAIL DR",
"city": "GARLAND",
"state": "TX",
"postal_code": "750446790",
"telephone_number": "468-888-3048"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6965 CUMBERLAND GAP PKWY",
"city": "HARROGATE",
"state": "TN",
"postal_code": "377528231",
"telephone_number": "423-869-3611"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHAM",
"first_name": "MASON",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-06-20",
"last_updated": "2025-12-19",
"certification_date": "2025-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "KY",
"license": "4050471",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Harrogate, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2025; 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.