Individual provider Active NPI

Jerromy Jones, CRNA

  • Certified Registered Nurse Anesthetist
  • Yukon, OK
National Provider Identifier
1417030263
Registry record updated Aug 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
67464 Issued in OK
Practice address
1201 Health Center Pkwy
Yukon, OK 73099-6381
Phone
(405) 717-6800
Fax
(405) 717-7964
NPI assigned
Oct 23, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 10, 2017

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 67464 OK Primary

Addresses

Primary practice location

1201 Health Center Pkwy
Yukon, OK 73099-6381

Mailing address

4301 Mow Way Road
Fort Sill, OK 73503-6300

Other identifiers 1

IdentifierTypeStateIssuer
200097480AMedicaidOK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070130000734 OK Practitioner - Certified Registered Nurse Anesthetist (Crna) 2365443504 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Medical Professionals PLLCGroup PAC ID 5991970279, 103 clinicians

Practice addresses (Care Compare)

1201 Health Ctr Pkwy
Yukon, OK 73099-6381
Phone (405) 717-6800

4801 Integris Pkwy
Edmond, OK 73034-8864
Phone (405) 713-4565

Hospital & facility affiliations

  • Integris Canadian Valley Hospital Hospital, Yukon, OK, CCN 370211

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
67464OKMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Integris Ambulatory Care Corporation CurrentSince Oct 1, 2013 Accepting new patients
Anesthesia Medical Professionals, PLLC CurrentSince Feb 1, 2012 Accepting new patients
Canadian Valley Anesthesia Services Past Accepting new patients

Locations

4801 Integris Pkwy
Edmond, OK 73034
Phone (405) 657-3000

3400 NW Expressway
Ste 500
Oklahoma City, OK 73112
Phone (405) 945-4589

1201 Health Center Pkwy
Yukon, OK 73099
Phone (405) 717-6800

1201 Health Center Pkwy
#I
Yukon, OK 73099
Phone (405) 717-6800

Organizations & group practices 3

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.

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": "1161561600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1502323200000",
    "number": "1417030263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4301 MOW WAY ROAD",
            "city": "FORT SILL",
            "state": "OK",
            "postal_code": "735036300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 HEALTH CENTER PKWY",
            "city": "YUKON",
            "state": "OK",
            "postal_code": "730996381",
            "telephone_number": "405-717-6800",
            "fax_number": "405-717-7964"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JONES",
        "first_name": "JERROMY",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-23",
        "last_updated": "2017-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OK",
            "license": "67464",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200097480A",
            "state": "OK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Yukon, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2017; 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.