NPIMap

Individual provider Active NPI

Graham T Gardner, CRNA

  • Certified Registered Nurse Anesthetist
  • Hattiesburg, MS
National Provider Identifier
1306272976
Registry record updated Dec 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R876117 Issued in MS
Practice address
4 Willow PT Ste 1B
Hattiesburg, MS 39402-1150
Phone
(601) 987-6580
NPI assigned
Sep 16, 2013
Last updated
Dec 4, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2023

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 R876117 MS Primary

Addresses

Primary practice location

4 Willow PT Ste 1B
Hattiesburg, MS 39402-1150

Mailing address

4 Willow PT Ste 1B
Hattiesburg, MS 39402-1150
Phone (601) 987-6580

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140203000444 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 1759510225 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

4 Willow PT
Suite 1B
Hattiesburg, MS 39402-1150
Phone (601) 582-6069

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R876117MSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
North Sunflower Medical Center CurrentSince Sep 16, 2024 Accepting new patients
Southerncare Anesthetics LLC CurrentSince Jul 1, 2023 Accepting new patients
North Sunflower Medical Center CurrentSince Sep 16, 2024 Accepting new patients
Lifelinc Anesthesia, PLLC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2018 Accepting new patients
North Sunflower Medical Center Current Accepting new patients
QHG of Hattiesburg Inc Past Accepting new patients

Locations

901 E Sunflower Rd
Cleveland, MS 38732
Phone (662) 846-0061

634 Leigh Dr
Columbus, MS 39705
Phone (601) 978-3393

4 Willow Pt
Ste 1B
Hattiesburg, MS 39402
Phone (601) 582-6069

5001 Hardy St
Hattiesburg, MS 39402
Phone (601) 268-8000

3882 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 872-6290

499 Azalea Dr
Oxford, MS 38655
Phone (662) 234-7979

840 N Oak Ave
Ruleville, MS 38771
Phone (601) 756-2711

Interoperability endpoints

  • Direct secure messaging: southerncareanestheticsllc.grahamgardner@155652.advancedmd-direct.com

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.

Hospital & facility affiliations 66

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

View all 66

NPI Registry JSON

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

{
    "created_epoch": "1379289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701648000000",
    "number": "1306272976",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4 WILLOW PT STE 1B",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021150",
            "telephone_number": "601-987-6580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4 WILLOW PT STE 1B",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394021150",
            "telephone_number": "601-987-6580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARDNER",
        "first_name": "GRAHAM",
        "middle_name": "T",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-09-16",
        "last_updated": "2023-12-04",
        "certification_date": "2023-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "R876117",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hattiesburg, MS

Sources for this page

Verify at the official NPI Registry.