Jacob Paulk, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

RN181759 Issued in GA

Practice address

901 18TH St E
Tifton, GA 31794-3648

Phone

(229) 353-6124

Fax

(229) 353-7722

NPI assigned

Apr 12, 2011

Last updated

Dec 16, 2020By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2010

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Coffee Regional Medical Center IncGroup PAC ID 4587656012, 29 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Coffee Regional Medical Center, Inc Hospital, Douglas, GA, CCN 110089

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

Practice roles

Locations

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.

• Coffee Regional Medical Center, Inc

  • Anesthesiology Physician
  • Douglas, GA
  • NPI 1437120946

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Southern Sleepers Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Douglas, GA
  • NPI 1720520646

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Sweet Dreams Anesthesiology Nurses of Georgia LLC

  • Certified Registered Nurse Anesthetist
  • Macon, GA
  • NPI 1669737409

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Sweet Dreams Nurse Anesthesia, Inc.

  • Certified Registered Nurse Anesthetist
  • Alpharetta, GA
  • NPI 1649463365

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Coffee Regional Medical Center, Inc

  dba Coffee Regional First Care

  • Rural Health Clinic/Center
  • Douglas, GA
  • NPI 1639211956
  NPD
• Coffee Regional Medical Center, Inc

  dba Coffee Regional Medical Center

  • General Acute Care Hospital
  • Douglas, GA
  • NPI 1760419527
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Coffee Regional Medical Center, Inc

  dba Coffee Regional Medical Center

  • General Acute Care Hospital
  • Douglas, GA
  • NPI 1760419527
  Care Compare affiliation

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

{
    "created_epoch": "1302566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608076800000",
    "number": "1215227202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "209 TILLMAN PAULK RD",
            "city": "AMBROSE",
            "state": "GA",
            "postal_code": "315123486",
            "telephone_number": "229-548-5137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 18TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943648",
            "telephone_number": "229-353-6124",
            "fax_number": "229-353-7722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAULK",
        "first_name": "JACOB",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-12",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN181759",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "RN181759",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaitlyn Kennedy Patterson, PHARMD
• Moritza Sade Paulhill, FNP
• Ansley Nicole Paulk
• Christine Paulk, FNP-BC
• Eric Michael Paulk
• Kayla Paulk
• Deidre Celeste Peacock, NP
• Pediatric Dental Center of Georgia
• Lashley Peeples
• Kathryn H. Perri, P.A.-C.

• Certified Registered Nurse Anesthetist in Tifton, GA
• Providers in Tifton, GA by specialty
• Certified Registered Nurse Anesthetist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2020; 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.