Individual provider Active NPI

Gregory James McKinney, CRNA

  • Certified Registered Nurse Anesthetist
  • Jackson, WY
National Provider Identifier
1376975037
Registry record updated Feb 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
41799.1797 Issued in WY
Practice address
625 E Broadway Ave
Jackson, WY 83001-8642
Phone
(307) 739-7218
Fax
(307) 739-7446
NPI assigned
Aug 5, 2013
Last updated
Feb 15, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 15, 2021

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 41799.1797 WY Primary

Addresses

Primary practice location

625 E Broadway Ave
Jackson, WY 83001-8642

Mailing address

625 E Broadway Ave Box 428
Jackson, WY 83001-0428
Phone (307) 739-7218

Other identifiers 1

IdentifierTypeStateIssuer
150883100MedicaidWY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gmckinney@sjmc.cernerdirect.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WY, AK2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20181109000809 WY Practitioner - Certified Registered Nurse Anesthetist (Crna) 4880828086 Reassigns benefits to 1 organization
I20231102002696 AK Practitioner - Certified Registered Nurse Anesthetist (Crna) 4880828086 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Anchorage Anesthesia Medical Group PCGroup PAC ID 2163414830, 52 clinicians

Practice addresses (Care Compare)

3300 Providence Dr
Suite 207
Anchorage, AK 99508-4620
Phone (907) 561-0005

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Ncap Imh, LLC CurrentSince Feb 2, 2022 Accepting new patients
Providence Anchorage Anesthesia Medical Group, P.C. CurrentSince Oct 3, 2023 Accepting new patients

Locations

3200 Providence Dr
Anchorage, AK 99508
Phone (907) 261-3111

3300 Providence Dr
Ste 207
Anchorage, AK 99508
Phone (907) 279-0555

3702 Automation Way
Ste 103
Fort Collins, CO 80525
Phone (970) 495-6201

255 N 30th St
Laramie, WY 82072
Phone (307) 742-2141

Interoperability endpoints

  • Direct secure messaging: gmckinney@sjmc.cernerdirect.com

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": "1375660800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1613347200000",
    "number": "1376975037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 E BROADWAY AVE BOX 428",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830010428",
            "telephone_number": "307-739-7218",
            "fax_number": "307-739-7446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 E BROADWAY AVE",
            "city": "JACKSON",
            "state": "WY",
            "postal_code": "830018642",
            "telephone_number": "307-739-7218",
            "fax_number": "307-739-7446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKINNEY",
        "first_name": "GREGORY",
        "middle_name": "JAMES",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-08-05",
        "last_updated": "2021-02-15",
        "certification_date": "2021-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WY",
            "license": "41799.1797",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150883100",
            "state": "WY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gmckinney@sjmc.cernerdirect.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging Address for St John's Health",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Other",
            "address_1": "625 E Broadway Ave",
            "city": "Jackson",
            "state": "WY",
            "country_code": "US",
            "postal_code": "830018642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Jackson, WY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2021; 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.