Jarrod P Fontenelle, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · McComb, MS
NPI 1326524869 · NPPES record last updated Jul 18, 2018
Key facts
- NPI
- 1326524869
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- R863487 (MS)
- Practice address
- 215 Marion Ave
McComb, MS 39648-2705 - Phone
- (334) 279-1450
- Fax
- (334) 279-1660
- NPI assigned
- Jul 18, 2018
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- McComb Anesthesia Associates, LLP
Practice addresses (Care Compare)
215 Marion Ave
McComb, MS 39648-2705
Phone (601) 249-5500
Hospital & facility affiliations
- Southwest Ms Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180830000832 | MS | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 9739439464 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R863487 | MS | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| McComb Anesthesia Associates, LLP | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Youngs Professional Services LLC | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
Locations
2781 C T Switzer SR Dr
Ste 101
Biloxi, MS 39531
Phone (228) 594-2900
215 Marion Ave
McComb, MS 39648
Phone (601) 249-1180
1926 23rd Ave
Meridian, MS 39301
Phone (601) 485-1131
3882 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 872-6290
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | R863487 | MS | Yes |
Addresses
Primary practice location
215 Marion Ave
McComb, MS 39648-2705
Mailing address
PO Box 235019
Montgomery, AL 36123-5019
Phone (334) 279-1450
Other providers in McComb, MS
- Jordan Felder Field
- Mary Jill Fisher
- Alice Fletcher
- Christina Jolene Floyd
- Cindy Foley
- Foot Care and Surgical Center
- Patricia Ilene Ford
- Emily Foreman
- Cameron Givens Foret
- Lasontiga Forrest
All providers in McComb, MS · Certified Registered Nurse Anesthetist in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.