NPIMap

Organization Active NPI

Northeast Tennessee Anesthesia, PLLC

  • Certified Registered Nurse Anesthetist
  • Kingsport, TN
National Provider Identifier
1437436102
Registry record updated Oct 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
NORTHEAST TENNESSEE ANESTHESIA, PLLC
Practice address
10461 Wallace Alley Drive
Kingsport, TN 37663-3936
Phone
(423) 279-1414
Fax
(423) 279-1410
NPI assigned
Nov 9, 2011
Last updated
Oct 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 21, 2022

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

Authorized official

Name
Michelle Carmela Merritt
Title
Practice Adminstrator
Phone
(423) 279-1414

Specialties & licenses 1

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

Addresses

Primary practice location

10461 Wallace Alley Drive
Kingsport, TN 37663-3936

Mailing address

10461 Wallace Alley Drive
Kingsport, TN 37663-3936
Phone (423) 279-1414

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111207000018 TN Part B Supplier - Clinic/Group Practice 2163697996 Receives reassigned benefits from 28 practitioners
Practice locations: Kingsport, TN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 28

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.

View all 28

NPI Registry JSON

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

{
    "created_epoch": "1320796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666310400000",
    "number": "1437436102",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10461 WALLACE ALLEY DRIVE",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376633936",
            "telephone_number": "423-279-1414",
            "fax_number": "843-357-4940"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10461 WALLACE ALLEY DRIVE",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376633936",
            "telephone_number": "423-279-1414",
            "fax_number": "423-279-1410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHEAST TENNESSEE ANESTHESIA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-09",
        "last_updated": "2022-10-21",
        "certification_date": "2022-10-21",
        "status": "A",
        "authorized_official_last_name": "MERRITT",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "CARMELA",
        "authorized_official_title_or_position": "PRACTICE ADMINSTRATOR",
        "authorized_official_telephone_number": "423-279-1414"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2022; 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.