NPIMap

Organization Active NPI

Jefferson Regional Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Pine Bluff, AR
National Provider Identifier
1205301587
Registry record updated Oct 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
JEFFERSON REGIONAL ANESTHESIA LLC
Practice address
1600 W 40TH Ave
Pine Bluff, AR 71603-6301
Phone
(870) 541-7370
Fax
(870) 541-7665
NPI assigned
Oct 12, 2018
Last updated
Oct 12, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 12, 2018

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

Authorized official

Name
Mr. Bryan G Jackson
Title
Cfo
Phone
(870) 541-7370

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

1600 W 40TH Ave
Pine Bluff, AR 71603-6301

Mailing address

1600 W 40TH Ave
Pine Bluff, AR 71603-6301
Phone (870) 541-7370

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20181231000163 AR Part B Supplier - Clinic/Group Practice 6204171846 Receives reassigned benefits from 34 practitioners
Practice locations: Pine Bluff, AR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 34

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.

View all 34

NPI Registry JSON

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

{
    "created_epoch": "1539302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539302400000",
    "number": "1205301587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 W 40TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036301",
            "telephone_number": "870-541-7370",
            "fax_number": "870-541-7665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 W 40TH AVE",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036301",
            "telephone_number": "870-541-7370",
            "fax_number": "870-541-7665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEFFERSON REGIONAL ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-12",
        "last_updated": "2018-10-12",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "870-541-7370",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pine Bluff, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2018; 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.