Individual provider Active NPI

Johnathan Mougin, CRNA

  • Certified Registered Nurse Anesthetist
  • Tucson, AZ
National Provider Identifier
1356953954
Registry record updated Jul 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
294669 Issued in AZ
Practice address
350 N Wilmot Rd
Tucson, AZ 85711-2602
Phone
(520) 873-3000
NPI assigned
Aug 17, 2020
Last updated
Jul 24, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 24, 2023

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 294669 AZ Primary
Registered Nurse 163W00000X RN205860 AZ

Addresses

Primary practice location

350 N Wilmot Rd
Tucson, AZ 85711-2602

Mailing address

4180 W Golder Star PL
Tucson, AZ 85745-4116

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230804002043 AZ Practitioner - Certified Registered Nurse Anesthetist (Crna) 5890156939 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northwest HBP Medical Services LLCGroup PAC ID 8921356536, 278 clinicians

Practice addresses (Care Compare)

6200 N la Cholla Blvd
Tucson, AZ 85741-3529
Phone (520) 229-2657

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
294669AZMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Partners & Management LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 7, 2023 Accepting new patients
Northwest HBP Medical Services LLC CurrentSince Nov 8, 2024 Accepting new patients

Locations

1020 N San Francisco St
Ste 100
Flagstaff, AZ 86001
Phone (928) 774-2300

103 Medicine Way Rd
Peridot, AZ 85542
Phone (928) 475-1200

3900 E Camelback Rd
Ste 190
Phoenix, AZ 85018
Phone (888) 724-6236

4600 E Washington St
Ste 300
Phoenix, AZ 85034
Phone (602) 638-1872

3110 Clearwater Dr
Prescott, AZ 86305
Phone (623) 241-6185

1601 W Saint Marys Rd
Tucson, AZ 85745
Phone (520) 622-5833

1704 W Anklam Rd
Ste 108
Tucson, AZ 85745
Phone (623) 241-6185

350 N Wilmot Rd
Tucson, AZ 85711
Phone (520) 873-3000

350 S Wilmot Rd
Tucson, AZ 85711

6200 N La Cholla Blvd
Tucson, AZ 85741
Phone (520) 229-2657

1030 W 24th St
Ste H
Yuma, AZ 85364
Phone (520) 726-5151

Organizations & group practices 2

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 1

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

NPI Registry JSON

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

{
    "created_epoch": "1597622400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690156800000",
    "number": "1356953954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4180 W GOLDER STAR PL",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857454116"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 N WILMOT RD",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857112602",
            "telephone_number": "520-873-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOUGIN",
        "first_name": "JOHNATHAN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-08-17",
        "last_updated": "2023-07-24",
        "certification_date": "2023-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AZ",
            "license": "294669",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "AZ",
            "license": "RN205860",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2023; 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.