Individual provider Active NPI

James Allen Mitchell, CRNA

  • Certified Registered Nurse Anesthetist
  • Springfield, IL
National Provider Identifier
1255799391
Registry record updated May 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209.013804 Issued in IL
Practice address
1025 S 6TH St
Springfield, IL 62703
Phone
(217) 528-7541
Fax
(217) 527-8956
NPI assigned
Feb 3, 2016
Last updated
May 24, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 24, 2018

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 209.013804 IL Primary
Registered Nurse 163W00000X 041.384446 IL

Addresses

Primary practice location

1025 S 6TH St
Springfield, IL 62703

Mailing address

1025 S 6TH St
Springfield, IL 62703-2499
Phone (217) 528-7541

Other practice location 1

1800 E Lake Shore Dr
Decatur, IL 62521-3810
Phone (217) 464-2966

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191024002186 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 2668744392 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gi Anesthesia of Georgia LLCGroup PAC ID 0446516769, 117 clinicians

Practice addresses (Care Compare)

4275 Johns Creek Pkwy
Suite a
Suwanee, GA 30024-9117
Phone (678) 475-1606

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041.384446ILMDRegistered Nurse
209.013804ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Dynamics LLC Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2020 Accepting new patients
Walton Anesthesia Associates, PC CurrentSince Sep 10, 2021 Accepting new patients
Gi Anesthesia of Georgia LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 1, 2021 Accepting new patients
Coastal Ambulatory Anesthesia LLC CurrentSince Nov 18, 2021 Accepting new patients
Gastroenterology Anesthesia Associates, LLC Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2019 Accepting new patients
Memorial Medical Center Past Accepting new patients

Locations

7956 Vaughn Rd
Ste 165
Montgomery, AL 36116

340 N Milledge Ave
Ste A
Athens, GA 30601
Phone (706) 548-0008

550 Peachtree St NE
Ste 1600
Atlanta, GA 30308
Phone (404) 881-1094

1515 River Pl
Ste 320
Braselton, GA 30517
Phone (678) 997-2125

2675 N Decatur Rd
Ste 506
Decatur, GA 30033
Phone (404) 299-1679

8855 Hospital Dr
Ste 102
Douglasville, GA 30134
Phone (678) 784-5020

1955 Textile Way
Gainesville, GA 30501
Phone (678) 987-1499

2324 Limestone Overlook
Ste 200
Gainesville, GA 30501
Phone (312) 724-7441

226 E College St
#A
Griffin, GA 30224
Phone (678) 987-1490

301 Philip Blvd
Ste B
Lawrenceville, GA 30046
Phone (770) 682-7220

488 Kennesaw Ave NW
Ste 100
Marietta, GA 30060
Phone (770) 427-3075

2151 W Spring St
Monroe, GA 30655
Phone (770) 267-1792

34 Upper Riverdale Rd SE
Ste 201
Riverdale, GA 30274
Phone (678) 904-0094

5671 Ptree Dunwoody Rd NE
Ste 680
Sandy Springs, GA 30342
Phone (404) 705-6985

1139 Lexington Ave
Savannah, GA 31404
Phone (912) 303-4200

150 N Park Trl
#A
Stockbridge, GA 30281
Phone (770) 507-0909

4275 Johns Creek Pkwy
Ste A
Suwanee, GA 30024
Phone (678) 475-1606

1360 Caduceus Way
Bldg 300
Watkinsville, GA 30677
Phone (706) 850-4985

900 Towne Lake Pkwy
Ste 310
Woodstock, GA 30189
Phone (770) 926-0071

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1454457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1527120000000",
    "number": "1255799391",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 S 6TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627032499",
            "telephone_number": "217-528-7541"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 S 6TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "62703",
            "telephone_number": "217-528-7541",
            "fax_number": "217-527-8956"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 E Lake Shore Dr",
            "address_purpose": "LOCATION",
            "city": "Decatur",
            "state": "IL",
            "postal_code": "625213810",
            "country_code": "US",
            "telephone_number": "217-464-2966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "JAMES",
        "middle_name": "ALLEN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-02-03",
        "last_updated": "2018-05-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209.013804",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.384446",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2018; 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.