Individual provider Active NPI

Jeffrey Scott Medders, CRNA

  • Certified Registered Nurse Anesthetist
  • Tuscaloosa, AL
National Provider Identifier
1154364735
Registry record updated Nov 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1-066895 Issued in AL
Practice address
809 University Blvd E
Tuscaloosa, AL 35401-2029
Phone
(205) 759-7352
Fax
(205) 759-6397
NPI assigned
Jun 13, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2010

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 1-066895 AL
Certified Registered Nurse Anesthetist 367500000X 1-066895 AL Primary

Addresses

Primary practice location

809 University Blvd E
Tuscaloosa, AL 35401-2029

Mailing address

809 University Blvd E
Tuscaloosa, AL 35401-2029
Phone (205) 759-7352

Other identifiers 1

IdentifierTypeStateIssuer
075123OtherALAMERICAN ASSOCIATION OF NURSE ANESTHETISTS (CERTIFICATION)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060419000281 AL Practitioner - Certified Registered Nurse Anesthetist (Crna) 0941219976 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northport - CrnaGroup PAC ID 3971791286, 27 clinicians

Practice addresses (Care Compare)

2700 Hospital Dr
Northport, AL 35476-3360
Phone (205) 333-4500

Hospital & facility affiliations

  • DCH Regional Medical Center Hospital, Tuscaloosa, AL, CCN 010092

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1-066895ALMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
DCH Medical Center Crna Nurse Anesthetist, Certified Registered CurrentSince May 31, 2017 Accepting new patients
Northport - Crna Nurse Anesthetist, Certified Registered CurrentSince Jul 15, 2024 Accepting new patients

Locations

2700 Hospital Dr
Northport, AL 35476
Phone (205) 333-4500

809 University Blvd E
Tuscaloosa, AL 35401
Phone (205) 333-4661

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 and National Provider Directory roles.

Hospital & facility affiliations 3

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": "1150156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1288915200000",
    "number": "1154364735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "809 UNIVERSITY BLVD E",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354012029",
            "telephone_number": "205-759-7352",
            "fax_number": "205-759-6397"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "809 UNIVERSITY BLVD E",
            "city": "TUSCALOOSA",
            "state": "AL",
            "postal_code": "354012029",
            "telephone_number": "205-759-7352",
            "fax_number": "205-759-6397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDDERS",
        "first_name": "JEFFREY",
        "middle_name": "SCOTT",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-13",
        "last_updated": "2010-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "1-066895",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AL",
            "license": "1-066895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN ASSOCIATION OF NURSE ANESTHETISTS (CERTIFICATION)",
            "identifier": "075123",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tuscaloosa, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2010; 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.