Individual provider Active NPI

Jon S. Fannin, CRNA

  • Certified Registered Nurse Anesthetist
  • Kerrville, TX
National Provider Identifier
1376582551
Registry record updated Oct 23, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R43299 Issued in NM
Practice address
710 Water St
Kerrville, TX 78028-5329
Phone
(830) 896-1344
NPI assigned
Jun 5, 2006
Last updated
Oct 23, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2007

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 R43299 NM Primary

Addresses

Primary practice location

710 Water St
Kerrville, TX 78028-5329

Mailing address

420 Water St
105-B
Kerrville, TX 78028-5200
Phone (830) 896-1344

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM, TX, FL3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20060110000822 NM Practitioner - Certified Registered Nurse Anesthetist (Crna) 1153343314 Reassigns benefits to 1 organization
I20070131000451 TX Practitioner - Certified Registered Nurse Anesthetist (Crna) 1153343314 Reassigns benefits to 1 organization
I20210318001195 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 1153343314 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Street Anesthesia of New Mexico, LLCGroup PAC ID 3476807538, 228 clinicians

Practice addresses (Care Compare)

117 E 19TH St
Lovelace Regional Hospital Roswell
Roswell, NM 88201-5151
Phone (575) 627-7000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R43299NMMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Ams Baptist LLC Nurse Anesthetist, Certified Registered CurrentSince May 2, 2022 Accepting new patients
Main Street Anesthesia of New Mexico, LLC CurrentSince Oct 22, 2023 Accepting new patients
Gulf-to-Bay Anesthesiology Associates LLC CurrentSince Feb 1, 2021 Accepting new patients
Ams of Gulf Breeze LLC Nurse Anesthetist, Certified Registered CurrentSince May 2, 2022 Accepting new patients
Sunshine State Anesthesia Partners LLC CurrentSince Feb 28, 2021 Accepting new patients
Emergenchealth PLLC Nurse Anesthetist, Certified Registered CurrentSince Nov 1, 2021 Accepting new patients
Gulf-to-Bay Anesthesiology Associates LLC Nurse Anesthetist, Certified Registered CurrentSince Feb 1, 2021 Accepting new patients
Las Palmas del Sol Cardiology, PLLC Past Accepting new patients
Etap Group Inc Nurse Anesthetist, Certified Registered Past Accepting new patients
Asf Group Inc Nurse Anesthetist, Certified Registered Past Accepting new patients
Kentucky Rehabilitation Services Inc Past Accepting new patients
Texas Anesthesia Specialists PA Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

24040 Tamiami Trl
Bonita Springs, FL 34134
Phone (239) 624-7153

2020 59th St W
Bradenton, FL 34209
Phone (813) 798-6303

15238 Virginia Sta
Odessa, FL 33556
Phone (813) 596-5200

1110 Gulf Breeze Pkwy
Pensacola Beach, FL 32561
Phone (850) 438-1848

14000 Fivay Rd
Port Richey, FL 34667
Phone (727) 819-2929

4016 Sun City Center Blvd
Sun City Ctr, FL 33573
Phone (813) 634-0145

9330 State Road 54
Trinity, FL 34655
Phone (727) 834-4000

1 Tampa General Cir
University of Tampa, FL 33606
Phone (813) 251-0793

117 E 19th St
Roswell, NM 88201
Phone (505) 727-2000

405 W Country Club Rd
Roswell, NM 88201
Phone (505) 622-8170

7400 Barlite Blvd
San Antonio, TX 78224
Phone (210) 921-2000

Organizations & group practices 12

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": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193097600000",
    "number": "1376582551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 WATER ST",
            "address_2": "105-B",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780285200",
            "telephone_number": "830-896-1344",
            "fax_number": "830-896-1363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 WATER ST",
            "city": "KERRVILLE",
            "state": "TX",
            "postal_code": "780285329",
            "telephone_number": "830-896-1344"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANNIN",
        "first_name": "JON",
        "middle_name": "S.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2007-10-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NM",
            "license": "R43299",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kerrville, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2007; 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.