NPIMap

Individual provider Active NPI

Antonio Gamble

  • Certified Registered Nurse Anesthetist
  • Jackson, MS
National Provider Identifier
1154420925
Registry record updated Dec 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R861375 Issued in MS
Practice address
2500 N State St
Jackson, MS 39216-4500
Phone
(601) 984-5900
NPI assigned
Sep 21, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2010

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 R861375 MS Primary

Addresses

Primary practice location

2500 N State St
Jackson, MS 39216-4500

Mailing address

243 Catalina Circle
Jackson, MS 39204
Phone (601) 981-6036

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080718000254 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 7012080450 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
University of Alabama School of Medicine, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Perioperative Services of Mississippi, LLC 98 clinicians
State of Mississippi - University of Mississippi Medical Center 956 clinicians
Physicians Anesthesia Group, P.a. 54 clinicians

Practice addresses (Care Compare)

1225 N State St
Ms Baptist Medical Center
Jackson, MS 39202-2064
Phone (601) 317-2802

2500 N State St
Jackson, MS 39216-4500
Phone (601) 898-4404

350 Crossgates Blvd
Brandon, MS 39042-2601
Phone (604) 317-2802

960 Avent Dr
Grenada, MS 38901-5230
Phone (662) 227-7000

971 Lakeland Dr
Jackson, MS 39216-4643
Phone (601) 200-2000

Hospital & facility affiliations

  • St Dominic-Jackson Memorial Hospital Hospital, Jackson, MS, CCN 250048
  • University of Mississippi Med Center Hospital, Jackson, MS, CCN 250001
  • Mississippi Baptist Medical Center Hospital, Jackson, MS, CCN 250102

Merit-based Incentive Payment System (MIPS)

Final score
83.94 of 100Reported as group
Quality
67.75
Promoting interoperability
100
Improvement activities
40
Cost
71.17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R861375MSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jul 1, 2006 Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Jul 1, 2006 Accepting new patients
State of Mississippi-University of Mississippi Medical Center Nurse Anesthetist, Certified Registered CurrentSince Jun 23, 2015 Accepting new patients
Perioperative Services of Mississippi, LLC CurrentSince Mar 15, 2022 Accepting new patients
Physicians Anesthesia Group, P.a. CurrentSince Apr 19, 2022 Accepting new patients

Locations

350 Crossgates Blvd
Brandon, MS 39042
Phone (601) 824-8500

960 Avent Dr
#J
Grenada, MS 38901
Phone (662) 227-6450

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

971 Lakeland Dr
Jackson, MS 39216
Phone (601) 939-5922

239 Bowling Green Rd
Lexington, MS 39095
Phone (662) 834-1321

Organizations & group practices 25

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.

View all 25

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": "1158796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293667200000",
    "number": "1154420925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "243 CATALINA CIRCLE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "39204",
            "telephone_number": "601-981-6036"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAMBLE",
        "first_name": "ANTONIO",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-21",
        "last_updated": "2010-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "R861375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 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.