NPIMap

Organization Active NPI

John Fitzgibbon Memorial Hospital Inc

Doing business as Fitzgibbon Anesthesia Group

  • Certified Registered Nurse Anesthetist
  • Marshall, MO
National Provider Identifier
1386758654
Registry record updated Mar 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
JOHN FITZGIBBON MEMORIAL HOSPITAL INC
Doing business as
Fitzgibbon Anesthesia Group
Practice address
2305 S Highway 65
Marshall, MO 65340-3702
Phone
(660) 886-7431
NPI assigned
Aug 17, 2006
Last updated
Mar 5, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nancy Harris
Title
Cfo/Coo
Phone
(660) 886-7231

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X NU Primary

Addresses

Primary practice location

2305 S Highway 65
Marshall, MO 65340-3702

Mailing address

400 E 10TH St
Waconia, MN 55387-4552
Phone (952) 442-9770

Other identifiers 3

IdentifierTypeStateIssuer
00617033OtherMOBLUE CROSS OF KANSAS CITY
215045OtherMOBLUE CROSS OF MO-FEDERAL
501547608MedicaidMO

Other names 1

  • Fitzgibbon Anesthesia Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040315000980 MO Part B Supplier - Clinic/Group Practice 2567351570 Receives reassigned benefits from 68 practitioners
14 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marshall, MO; Pilot Grove, MO

Other NPIs on the same Medicare enrollment 14

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Eastwood Family Clinic9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

  • Andrew J Green, CRNA
    • Certified Registered Nurse Anesthetist
    • Columbia, MO
    • NPI 1467488429

    Nurse Anesthetist, Certified Registered

    NPD
  • Paul Peterson, CRNA
    • Certified Registered Nurse Anesthetist
    • Overland Park, KS
    • NPI 1861448524

    Nurse Anesthetist, Certified Registered

    NPD
  • Jacob Adam Poore, CRNA
    • Certified Registered Nurse Anesthetist
    • Fort Bliss, TX
    • NPI 1598433245

    Nurse Anesthetist, Certified Registered

    NPD
  • Logan Garrett Smith, CRNA DNP
    • Certified Registered Nurse Anesthetist
    • Kansas City, KS
    • NPI 1467975441

    Nurse Anesthetist, Certified Registered

    NPD

NPI Registry JSON

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

{
    "created_epoch": "1155772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709596800000",
    "number": "1386758654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 10TH ST",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553874552",
            "telephone_number": "952-442-9770",
            "fax_number": "952-442-3620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 S HIGHWAY 65",
            "city": "MARSHALL",
            "state": "MO",
            "postal_code": "653403702",
            "telephone_number": "660-886-7431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JOHN FITZGIBBON MEMORIAL HOSPITAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-17",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "CFO/COO",
        "authorized_official_telephone_number": "660-886-7231"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF KANSAS CITY",
            "identifier": "00617033",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF MO-FEDERAL",
            "identifier": "215045",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "501547608",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fitzgibbon Anesthesia Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Fitzgibbon Anesthesia Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Marshall, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.