NPIMap

Organization Active NPI

Fayette Medical Center-Crna

  • Certified Registered Nurse Anesthetist
  • Fayette, AL
National Provider Identifier
1194147637
Registry record updated Jul 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
FAYETTE MEDICAL CENTER-CRNA
Practice address
1653 Temple Ave N
Fayette, AL 35555-1314
Phone
(205) 923-5966
Fax
(205) 932-1260
NPI assigned
Jan 17, 2014
Last updated
Jul 2, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2026

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

Authorized official

Name
David Herman
Title
VP Finance
Phone
(205) 759-7297

Specialties & licenses 1

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

Addresses

Primary practice location

1653 Temple Ave N
Fayette, AL 35555-1314

Mailing address

1653 Temple Ave N
Fayette, AL 35555-1314
Phone (205) 923-5966

Other identifiers 1

IdentifierTypeStateIssuer
102G704766OtherALMEDICARE ID

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140402002181 AL Part B Supplier - Clinic/Group Practice 2365673415 Receives reassigned benefits from 12 practitioners
Practice locations: Fayette, AL

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 12

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": "1389916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782950400000",
    "number": "1194147637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1653 TEMPLE AVE N",
            "city": "FAYETTE",
            "state": "AL",
            "postal_code": "355551314",
            "telephone_number": "205-923-5966",
            "fax_number": "205-932-1260"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1653 TEMPLE AVE N",
            "city": "FAYETTE",
            "state": "AL",
            "postal_code": "355551314",
            "telephone_number": "205-923-5966",
            "fax_number": "205-932-1260"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAYETTE MEDICAL CENTER-CRNA",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-17",
        "last_updated": "2026-07-02",
        "certification_date": "2026-07-02",
        "status": "A",
        "authorized_official_last_name": "HERMAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "VP FINANCE",
        "authorized_official_telephone_number": "205-759-7297"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "102G704766",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayette, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2026; 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.