NPIMap

Organization Active NPI

Primary Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Fayetteville, GA
National Provider Identifier
1427640317
Registry record updated Feb 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
PRIMARY ANESTHESIA LLC
Practice address
874 Lanier Ave W Ste 260
Fayetteville, GA 30214-7669
Phone
(404) 618-0995
NPI assigned
Feb 11, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 11, 2021

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

Authorized official

Name
Wayne Paul-Bazil, MSNNPI 1588743991
Title
Member
Phone
(718) 877-3973

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

874 Lanier Ave W Ste 260
Fayetteville, GA 30214-7669

Mailing address

3904 N Druid Hills Rd Ste 325
Decatur, GA 30033-3105

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210405001643 GA Part B Supplier - Clinic/Group Practice 1456768662 Receives reassigned benefits from 6 practitioners
Practice locations: Fayetteville, GA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1613001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613001600000",
    "number": "1427640317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3904 N DRUID HILLS RD STE 325",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300333105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "874 LANIER AVE W STE 260",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302147669",
            "telephone_number": "404-618-0995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIMARY ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-02-11",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A",
        "authorized_official_last_name": "PAUL-BAZIL",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "718-877-3973",
        "authorized_official_credential": "MSN"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2021; 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.