Individual provider Active NPI

John Gollery

  • Certified Registered Nurse Anesthetist
  • Tampa, FL
National Provider Identifier
1407491152
Registry record updated Dec 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
APRN11005431 Issued in FL
Practice address
3100 E Fletcher Ave
Tampa, FL 33613-4613
Phone
(813) 971-6000
NPI assigned
Nov 16, 2019
Last updated
Dec 28, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 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 APRN11005431 FL Primary

Addresses

Primary practice location

3100 E Fletcher Ave
Tampa, FL 33613-4613

Mailing address

3100 E Fletcher Ave
Tampa, FL 33613-4613
Phone (813) 971-6000

Other practice location 1

13695 US Highway 1
Sebastian, FL 32958-3230
Phone (772) 589-3186

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, WA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200123001141 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 5799110680 Reassigns benefits to 3 organizations
I20250203002349 WA Practitioner - Certified Registered Nurse Anesthetist (Crna) 5799110680 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rainier Anesthesia Associates PCGroup PAC ID 4284523499, 69 clinicians

Practice addresses (Care Compare)

407 14TH Ave SE
Puyallup, WA 98372-3770
Phone (253) 848-6661

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
North Tampa Anesthesia Consultants CurrentSince Jan 2, 2020 Accepting new patients
Steward Anesthesiology Physicians of Florida Inc. CurrentSince Nov 15, 2021 Accepting new patients
Rainier Anesthesia Associates PC CurrentSince Feb 25, 2025 Accepting new patients
Capital Anesthesia Solutions of Florida II, LLC CurrentSince Oct 1, 2022 Accepting new patients

Locations

17240 Cortez Blvd
Brooksville, FL 34601
Phone (352) 544-6060

2222 S Harbor City Blvd
Ste 540
Melbourne, FL 32901
Phone (321) 541-1776

8300 Collier Blvd
Naples, FL 34114
Phone (239) 348-4000

13695 US Highway 1
Sebastian, FL 32958
Phone (772) 589-3185

10461 Quality Dr
Spring Hill, FL 34609
Phone (352) 688-3002

540 The Rialto
Venice, FL 34285
Phone (866) 481-2553

17700 SE 272nd St
Kent, WA 98042
Phone (253) 372-6500

104 27th Ave SE
Puyallup, WA 98374
Phone (253) 770-4099

407 14th Ave SE
Puyallup, WA 98372
Phone (253) 697-4000

Networks

  • Optimum HealthCare HMO Network
  • Freedom Health HMO Network

Organizations & group practices 4

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 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": "1573862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640649600000",
    "number": "1407491152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3100 E FLETCHER AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336134613",
            "telephone_number": "813-971-6000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3100 E FLETCHER AVE",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336134613",
            "telephone_number": "813-971-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "13695 US Highway 1",
            "address_purpose": "LOCATION",
            "city": "Sebastian",
            "state": "FL",
            "postal_code": "329583230",
            "country_code": "US",
            "telephone_number": "772-589-3186",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOLLERY",
        "first_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-11-16",
        "last_updated": "2021-12-28",
        "certification_date": "2021-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "APRN11005431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.