Individual provider Active NPI

Cornelia H Glenn, CRNA

  • Certified Registered Nurse Anesthetist
  • Dothan, AL
National Provider Identifier
1366586604
Registry record updated Jun 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1-088200 Issued in AL
Practice address
1118 Ross Clark Circle
Suite 700
Dothan, AL 36301-3030
Phone
(334) 793-5105
Fax
(334) 671-5073
NPI assigned
Feb 19, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 21, 2011

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 1-088200 AL Primary

Addresses

Primary practice location

1118 Ross Clark Circle
Suite 700
Dothan, AL 36301-3030

Mailing address

1118 Ross Clark Circle
Suite 700
Dothan, AL 36301-3030
Phone (334) 793-5105

Other names 1

  • Cornelia H McCann Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20070514000467 AL Practitioner - Certified Registered Nurse Anesthetist (Crna) 0648377325 Reassigns benefits to 2 organizations
I20170522001845 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 0648377325 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesiology Associates of Tallahassee IncGroup PAC ID 3476446014, 133 clinicians

Practice addresses (Care Compare)

2629 Welaunee Blvd
Tallahassee, FL 32308-4697
Phone (954) 939-5000

Hospital & facility affiliations

  • HCA Florida Capital Hospital Hospital, Tallahassee, FL, CCN 100254
  • Tallahassee Memorial Healthcare Hospital, Tallahassee, FL, CCN 100135

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1-088200ALMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesiology Associates of Tallahassee Inc Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2017 Accepting new patients
Houston County Healthcare Authority CurrentSince Jan 17, 2007 Accepting new patients
Houston County Healthcare Authority Current Accepting new patients
Medcore Associates, PLLC Current Accepting new patients
Pathology Laboratory Associates Current Accepting new patients
Houston County Healthcare Authority Nurse Anesthetist, Certified Registered CurrentSince Jan 17, 2007 Accepting new patients
Southern Alabama Surgery Center LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 30, 2010 Accepting new patients
Anesthesiology Associates of Tallahassee Inc Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

1108 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-3635

1118 Ross Clark Cir
Ste 700
Dothan, AL 36301
Phone (334) 793-5105

2800 Ross Clark Cir
Ste 3
Dothan, AL 36301
Phone (334) 793-3411

1300 Miccosukee Rd
Tallahassee, FL 32308
Phone (850) 431-1155

3334 Capital Medical Blvd
Ste 500
Tallahassee, FL 32308
Phone (850) 877-4688

2173 Centerville Pl
Ste A
Tallahassee, FL 32308

2626 Capital Medical Blvd
Tallahassee, FL 32308
Phone (850) 325-5000

2629 Welaunee Blvd
Tallahassee, FL 32308
Phone (850) 877-4688

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 2

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": "1171843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1308614400000",
    "number": "1366586604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 ROSS CLARK CIRCLE",
            "address_2": "SUITE 700",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013030",
            "telephone_number": "334-793-5105",
            "fax_number": "334-671-5073"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 ROSS CLARK CIRCLE",
            "address_2": "SUITE 700",
            "city": "DOTHAN",
            "state": "AL",
            "postal_code": "363013030",
            "telephone_number": "334-793-5105",
            "fax_number": "334-671-5073"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "CORNELIA",
        "middle_name": "H",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-19",
        "last_updated": "2011-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AL",
            "license": "1-088200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CORNELIA",
            "last_name": "MCCANN",
            "middle_name": "H",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Dothan, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2011; 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.