Individual provider Active NPI

Bryan F Jernigan II, CRNA

  • Certified Registered Nurse Anesthetist
  • Tulsa, OK
National Provider Identifier
1184600553
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
M127354 Issued in OK
Practice address
6161 S Yale Ave
Tulsa, OK 74136-1902
Phone
(918) 494-0612
NPI assigned
Dec 19, 2005
Last updated
Mar 11, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X M127354 OK Primary
Certified Registered Nurse Anesthetist 367500000X 11707 TN

Addresses

Primary practice location

6161 S Yale Ave
Tulsa, OK 74136-1902

Mailing address

6839 S Canton Ave
Tulsa, OK 74136-3402
Phone (918) 494-0612

Other practice location 1

4230 Harding Rd
Suite 435
Nashville, TN 37205-2013
Phone (615) 385-3704

Other identifiers 1

IdentifierTypeStateIssuer
3631357MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171110001951 OK Practitioner - Certified Registered Nurse Anesthetist (Crna) 5092732990 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osh Aai PLLCGroup PAC ID 4587818729, 73 clinicians
Associated Anesthesiologists, Inc.Group PAC ID 7911989017, 111 clinicians

Practice addresses (Care Compare)

6839 S Canton Ave
Tulsa, OK 74136-3402
Phone (918) 494-0612

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
M127354OKMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Osh Aai PLLC CurrentSince Sep 30, 2017 Accepting new patients
Anesthesia Medical Group, PC Nurse Anesthetist, Certified Registered Past Accepting new patients
Maury Regional Hospital Anesthesia Nurse Anesthetist, Certified Registered Past Accepting new patients
Anesthesia Care Enterprises, LLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Cardiovascular Anesthesiologists PC Nurse Anesthetist, Certified Registered PastSince Feb 27, 2012 Accepting new patients

Locations

6839 S Canton Ave
Tulsa, OK 74136
Phone (918) 494-0612

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1134950400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1184600553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6839 S CANTON AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741363402",
            "telephone_number": "918-494-0612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6161 S YALE AVE",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741361902",
            "telephone_number": "918-494-0612"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4230 Harding Rd",
            "address_2": "Suite 435",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372052013",
            "country_code": "US",
            "telephone_number": "615-385-3704",
            "fax_number": "615-292-1321",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JERNIGAN",
        "first_name": "BRYAN",
        "middle_name": "F",
        "name_prefix": "Mr.",
        "name_suffix": "II",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-19",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OK",
            "license": "M127354",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "11707",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3631357",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tulsa, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; 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.