NPIMap

Organization Active NPI

Irwin County Anesthesia, Inc.

  • Certified Registered Nurse Anesthetist
  • Ocilla, GA
National Provider Identifier
1275754103
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
IRWIN COUNTY ANESTHESIA, INC.
Practice address
710 N Irwin Ave
Ocilla, GA 31774-5011
Phone
(912) 389-1518
Fax
(912) 389-1518
NPI assigned
May 1, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Robert Juran Ray, CRNANPI 1801967120
Title
President
Phone
(912) 389-1518

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

710 N Irwin Ave
Ocilla, GA 31774-5011

Mailing address

206 Ward St E
Douglas, GA 31533-4600
Phone (912) 389-1518

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090630000646 GA Part B Supplier - Clinic/Group Practice 8426109588 Receives reassigned benefits from 35 practitioners
Practice locations: Ocilla, GA; Tifton, GA

National Provider Directory

National Provider Directory

Locations

206 Ward St E
Douglas, GA 31533

1948 Old Ocilla Rd
Ste B
Tifton, GA 31794
Phone (229) 386-5222

4280 Piedmont Pkwy
Ste 101
Greensboro, NC 27410

Practitioners & affiliated clinicians

Practitioners 41

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 41

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275754103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 WARD ST E",
            "city": "DOUGLAS",
            "state": "GA",
            "postal_code": "315334600",
            "telephone_number": "912-389-1518",
            "fax_number": "912-389-1518"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 N IRWIN AVE",
            "city": "OCILLA",
            "state": "GA",
            "postal_code": "317745011",
            "telephone_number": "912-389-1518",
            "fax_number": "912-389-1518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IRWIN COUNTY ANESTHESIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "JURAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "912-389-1518",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocilla, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.