NPIMap

Organization Active NPI

Martin Anesthesia Group Inc

  • Certified Registered Nurse Anesthetist
  • Martin, TN
National Provider Identifier
1326107327
Registry record updated Oct 20, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
MARTIN ANESTHESIA GROUP INC
Practice address
204 Poplar St
Martin, TN 38237-3121
Phone
(731) 588-0001
Fax
(731) 587-2775
NPI assigned
Dec 6, 2006
Last updated
Oct 20, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2011

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

Authorized official

Name
Paulette Smith Morel
Title
Office Manager
Phone
(731) 588-0001

Specialties & licenses 1

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

Addresses

Primary practice location

204 Poplar St
Martin, TN 38237-3121

Mailing address

204 Poplar St
Martin, TN 38237-3121
Phone (731) 588-0001

Other identifiers 1

IdentifierTypeStateIssuer
3631632MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040611001365 TN Part B Supplier - Clinic/Group Practice 1951384619 Receives reassigned benefits from 9 practitioners
Practice locations: Martin, TN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1319068800000",
    "number": "1326107327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "204 POPLAR ST",
            "city": "MARTIN",
            "state": "TN",
            "postal_code": "382373121",
            "telephone_number": "731-588-0001",
            "fax_number": "731-587-2775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "204 POPLAR ST",
            "city": "MARTIN",
            "state": "TN",
            "postal_code": "382373121",
            "telephone_number": "731-588-0001",
            "fax_number": "731-587-2775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARTIN ANESTHESIA GROUP INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2011-10-20",
        "status": "A",
        "authorized_official_last_name": "MOREL",
        "authorized_official_first_name": "PAULETTE",
        "authorized_official_middle_name": "SMITH",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "731-588-0001"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3631632",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Martin, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 2011; 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.