Individual provider Active NPI

Thomas Bradley Johnson, CRNA

  • Certified Registered Nurse Anesthetist
  • Jackson, MS
National Provider Identifier
1245312354
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R857848 Issued in MS
Practice address
1850 Chadwick Dr
Jackson, MS 39204-3404
Phone
(601) 376-1848
Fax
(601) 376-1894
NPI assigned
Oct 19, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R857848 MS Primary

Addresses

Primary practice location

1850 Chadwick Dr
Jackson, MS 39204-3404

Mailing address

PO Box 7539
Jackson, MS 39284-7539
Phone (601) 376-1848

Other identifiers 1

IdentifierTypeStateIssuer
00985356MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040903000101 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 8628044484 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Anesthesia Group, P.a.Group PAC ID 6103806864, 54 clinicians

Practice addresses (Care Compare)

971 Lakeland Dr
Jackson, MS 39216-4643
Phone (601) 200-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R857848MSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Jackson Anesthesia Associates PA CurrentSince May 1, 2022 Accepting new patients
Physicians Anesthesia Group, P.a. CurrentSince Aug 1, 2017 Accepting new patients
Surgical Anesthesia Associates, PA Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

1053 River Oaks Dr
#C
Flowood, MS 39232
Phone (601) 969-1430

971 Lakeland Dr
Jackson, MS 39216
Phone (601) 939-5922

Organizations & group practices 3

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": "1161216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245312354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7539",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392847539",
            "telephone_number": "601-376-1848",
            "fax_number": "601-376-1894"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 CHADWICK DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392043404",
            "telephone_number": "601-376-1848",
            "fax_number": "601-376-1894"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "THOMAS",
        "middle_name": "BRADLEY",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "R857848",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00985356",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.