Keith E Jackson, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Tuscaloosa, AL
NPI 1205866142 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1205866142
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 1-080730 (AL)
- Practice address
- 100 Rice Mine Rd N
Tuscaloosa, AL 35406-2300 - Phone
- (205) 354-0010
- NPI assigned
- Jul 4, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Patriot Perioperative Partners, Inc
Clay County Healthcare Authority
Practice addresses (Care Compare)
727 Memorial Dr
Bessemer, AL 35022-6029
Phone (205) 332-3160
83825 Hwy 9
Ashland, AL 36251-7981
Phone (256) 354-1195
Hospital & facility affiliations
- Clay County Hospital
- Clay County Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in AL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20040707000524 | AL | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 2567449572 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1-080730 | AL | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Patriot Perioperative Partners, Inc. | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Clay County Healthcare Authority | Current |
Accepting new patients | |
| Anesthesia Resources Management Solutions Inc | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
Locations
83825 Highway 9
Ashland, AL 36251
Phone (256) 354-1195
727 Memorial Dr
Bessemer, AL 35022
Phone (205) 332-3160
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 1-080730 | AL | Yes |
Addresses
Primary practice location
100 Rice Mine Rd N
Tuscaloosa, AL 35406-2300
Mailing address
712 Robin Rd
Birmingham, AL 35214-3524
Phone (205) 213-8420
Other providers in Tuscaloosa, AL
- Marhabo B Isoyeva
- Ivx,Inc
- Uchenna Jennifer Iwuaba
- J Barry Burgess
- Chad Jackson
- James V Mills Jr DMD
- Christopher James
- Arpitha Roy Jammula
- Jann'S Pharmacy, Inc.
- Aaron Jasper
All providers in Tuscaloosa, AL · Certified Registered Nurse Anesthetist in Alabama
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.