Individual provider Active NPI

Brenn Mitchell Johnson, CRNA

  • Certified Registered Nurse Anesthetist
  • Martin, TN
National Provider Identifier
1396166427
Registry record updated Dec 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN173849 Issued in TN
Practice address
161 Mount Pelia Rd
Martin, TN 38237-3811
Phone
(731) 588-0001
Fax
(731) 587-2775
NPI assigned
Dec 16, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 23, 2022

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 RN173849 TN Primary

Addresses

Primary practice location

161 Mount Pelia Rd
Martin, TN 38237-3811

Mailing address

410 N Cedar Bluff Rd
Ste 300
Knoxville, TN 37923-3632
Phone (865) 342-8900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140318001074 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 0244469773 Reassigns benefits to 3 organizations
I20230104000885 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 0244469773 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
West Tennessee Bone and Joint Clinic PCGroup PAC ID 7517940182, 64 clinicians

Practice addresses (Care Compare)

50 Capital Ave
Jackson, TN 38305-5507
Phone (731) 661-9825

Merit-based Incentive Payment System (MIPS)

Final score
91.05 of 100Reported as group
Promoting interoperability
98
Improvement activities
40
Cost
73.85

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
7062NCMDOccupational Therapist
RN173849TNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Vidant Medical Group LLC CurrentSince Dec 23, 2022 Accepting new patients
Medical Center Anesthesia Inc. Nurse Anesthetist, Certified Registered CurrentSince Oct 29, 2016 Accepting new patients
West Tennessee Bone and Joint Clinic PC Nurse Anesthetist, Certified Registered CurrentSince Jan 6, 2020 Accepting new patients
Jackson Anesthesiology Group, PLLC PastSince Dec 6, 2020 Accepting new patients

Locations

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

250 Smith Church Rd
Roanoke Rapids, NC 27870
Phone (252) 308-9699

620 Skyline Dr
Jackson, TN 38301
Phone (731) 541-4923

24 Physicians Dr
Jackson, TN 38305
Phone (731) 661-9825

50 Capital Ave
Jackson, TN 38305
Phone (731) 661-9825

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1387152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671753600000",
    "number": "1396166427",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 N CEDAR BLUFF RD",
            "address_2": "STE 300",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379233632",
            "telephone_number": "865-342-8900",
            "fax_number": "865-691-0843"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "161 MOUNT PELIA RD",
            "city": "MARTIN",
            "state": "TN",
            "postal_code": "382373811",
            "telephone_number": "731-588-0001",
            "fax_number": "731-587-2775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "BRENN",
        "middle_name": "MITCHELL",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-12-16",
        "last_updated": "2022-12-23",
        "certification_date": "2022-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "RN173849",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Martin, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2022; 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.