Individual provider Active NPI

Jasmin Jelissa Malloy, CRNA

  • Certified Registered Nurse Anesthetist
  • Atlanta, GA
National Provider Identifier
1457893489
Registry record updated Aug 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
GAA-CRNA001400 Issued in GA
Practice address
1968 Peachtree Rd NW
Atlanta, GA 30309-1281
Phone
(404) 605-3775
NPI assigned
Nov 8, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2026

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 9314734 FL
Certified Registered Nurse Anesthetist 367500000X GAA-CRNA001400 GA Primary
Certified Registered Nurse Anesthetist 367500000X 11014374 FL
Certified Registered Nurse Anesthetist 367500000X RN9314734 GA

Addresses

Primary practice location

1968 Peachtree Rd NW
Atlanta, GA 30309-1281

Mailing address

1011 NW 187TH Ave
Pembroke Pines, FL 33029-2913
Phone (954) 554-6902

Other practice location 1

3476 S University Dr
Davie, FL 33328-2000
Phone (954) 475-4400

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, FL, GA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20170808000003 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 2466723598 Reassigns benefits to 1 organization
I20220425001808 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 2466723598
I20240808004662 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 2466723598 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Anesthesia LLCGroup PAC ID 2163837972, 555 clinicians

Practice addresses (Care Compare)

1255 Hwy 54 W
Fayetteville, GA 30214
Phone (770) 719-7000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9314734FLMDGeneral Practice Registered Nurse
11014374FLMDCertified Registered Nurse Anesthetist
RN9314734GAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of Illinois, LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 17, 2017 Accepting new patients
Piedmont Anesthesia LLC CurrentSince May 1, 2025 Accepting new patients
Piedmont Anesthesia Associates, L.L.C CurrentSince Jul 1, 2024 Accepting new patients

Locations

1968 Ptree Rd NW
Atlanta, GA 30309
Phone (404) 605-2222

1984 Peachtree Rd NW
Ste 515
Atlanta, GA 30309
Phone (404) 351-1754

1255 Highway 54 W
Fayetteville, GA 30214
Phone (770) 719-6911

1133 Eagles Landing Pkwy
Stockbridge, GA 30281
Phone (678) 604-1000

20201 Crawford Ave
Olympia Flds, IL 60461
Phone (708) 503-3857

1423 Chicago Rd
Sauk Village, IL 60411
Phone (708) 679-2160

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

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": "1478563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786406400000",
    "number": "1457893489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1011 NW 187TH AVE",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330292913",
            "telephone_number": "954-554-6902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1968 PEACHTREE RD NW",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303091281",
            "telephone_number": "404-605-3775"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3476 S University Dr",
            "address_purpose": "LOCATION",
            "city": "Davie",
            "state": "FL",
            "postal_code": "333282000",
            "country_code": "US",
            "telephone_number": "954-475-4400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MALLOY",
        "first_name": "JASMIN",
        "middle_name": "JELISSA",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-11-08",
        "last_updated": "2026-08-11",
        "certification_date": "2026-08-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "FL",
            "license": "9314734",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "GAA-CRNA001400",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "11014374",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN9314734",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Atlanta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2026; 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.