Individual provider Active NPI

Samuel Edward Litsey

  • Certified Registered Nurse Anesthetist
  • Alpharetta, GA
National Provider Identifier
1215510441
Registry record updated Aug 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1-146697 Issued in AL
Practice address
2655 Northwinds Pkwy
Alpharetta, GA 30009-2280
Phone
(770) 643-5619
NPI assigned
May 5, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 1-146697 AL
Certified Registered Nurse Anesthetist 367500000X 1-146697 AL Primary

Addresses

Primary practice location

2655 Northwinds Pkwy
Alpharetta, GA 30009-2280

Mailing address

2655 Northwinds Pkwy
Alpharetta, GA 30009-2280
Phone (770) 643-5619

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20210603002700 AL Practitioner - Certified Registered Nurse Anesthetist (Crna) 4082013586 Reassigns benefits to 2 organizations
I20230405001983 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 4082013586 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sentry Anesthesia Management, LLCGroup PAC ID 9436372323, 170 clinicians

Practice addresses (Care Compare)

126 US Hwy 280 W
Americus, GA 31719-8645
Phone (229) 924-6011

1514 Vernon Rd
Lagrange, GA 30240-4131
Phone (706) 882-1411

Hospital & facility affiliations

  • Wellstar West Georgia Medical Center Hospital, Lagrange, GA, CCN 110016

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1-146697ALMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Amsol Anesthetists of Georgia, LLC Nurse Anesthetist, Certified Registered CurrentSince Mar 16, 2023 Accepting new patients
Amsol Anesthetists of Georgia LLC-Hughston Surgical Center Nurse Anesthetist, Certified Registered CurrentSince Mar 16, 2023 Accepting new patients
Premier Anesthesia of Montgomery PC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2021 Accepting new patients
Sentry Anesthesia Management, LLC CurrentSince Mar 22, 2023 Accepting new patients

Locations

2105 E South Blvd
Montgomery, AL 36116
Phone (334) 286-2842

4401 Riverchase Dr
Phenix City, AL 36867
Phone (334) 732-3000

13500 Powers Ct
Ste 230
Fort Myers, FL 33912
Phone (239) 610-0784

2655 Northwinds Pkwy
Alpharetta, GA 30009
Phone (678) 690-7804

126 US Highway 280 W
Americus, GA 31719
Phone (229) 924-6011

710 Center St
Columbus, GA 31901
Phone (706) 571-1000

Organizations & group practices 4

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

Hospital & facility affiliations 1

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": "1620172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661299200000",
    "number": "1215510441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2655 NORTHWINDS PKWY",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300092280",
            "telephone_number": "770-643-5619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2655 NORTHWINDS PKWY",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300092280",
            "telephone_number": "770-643-5619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LITSEY",
        "first_name": "SAMUEL",
        "middle_name": "EDWARD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-05-05",
        "last_updated": "2022-08-24",
        "certification_date": "2022-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AL",
            "license": "1-146697",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AL",
            "license": "1-146697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Alpharetta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2022; 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.