NPIMap

Organization Active NPI

Deep South Anesthesia, Inc

  • Certified Registered Nurse Anesthetist
  • Picayune, MS
National Provider Identifier
1164738712
Registry record updated Aug 20, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
DEEP SOUTH ANESTHESIA, INC
Practice address
801 Goodyear Blvd
Picayune, MS 39466-3221
Phone
(601) 798-4711
NPI assigned
Aug 20, 2010
Last updated
Aug 20, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2010

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

Authorized official

Name
Jason Todd Lane, CRNANPI 1003827478
Title
Crna/Owner
Phone
(800) 204-0099

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

801 Goodyear Blvd
Picayune, MS 39466-3221

Mailing address

200 Longstreet LN
Picayune, MS 39466-4413
Phone (800) 204-0099

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120523000317 MS Part B Supplier - Clinic/Group Practice 4284897612 Receives reassigned benefits from 6 practitioners
Practice locations: Gulfport, MS; Picayune, MS

National Provider Directory

National Provider Directory

Locations

130 Highland Pkwy
Picayune, MS 39466
Phone (601) 358-9400

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1282262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282262400000",
    "number": "1164738712",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 LONGSTREET LN",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394664413",
            "telephone_number": "800-204-0099",
            "fax_number": "336-882-2216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 GOODYEAR BLVD",
            "city": "PICAYUNE",
            "state": "MS",
            "postal_code": "394663221",
            "telephone_number": "601-798-4711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEEP SOUTH ANESTHESIA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-20",
        "last_updated": "2010-08-20",
        "status": "A",
        "authorized_official_last_name": "LANE",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "CRNA/OWNER",
        "authorized_official_telephone_number": "800-204-0099",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Picayune, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.