Individual provider Active NPI

Courtney R Graham, CRNA

  • Certified Registered Nurse Anesthetist
  • Hannibal, MO
National Provider Identifier
1487759502
Registry record updated Jul 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
146423 Issued in MO
Practice address
6000 Hospital Dr
Hannibal, MO 63401-6887
Phone
(573) 248-5621
Fax
(573) 248-5264
NPI assigned
Sep 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X C01442 AR
Certified Registered Nurse Anesthetist 367500000X 209006952 IL
Certified Registered Nurse Anesthetist 367500000X 146423 MO Primary

Addresses

Primary practice location

6000 Hospital Dr
Hannibal, MO 63401-6887

Mailing address

6000 Hospital Dr.
P.O. Box 551
Hannibal, MO 63401-0551
Phone (573) 248-5621

Other practice location 1

3301 Broadway St
Quincy, IL 62301-3713
Phone (217) 222-6550 ext. 3163

Other identifiers 1

IdentifierTypeStateIssuer
910840008MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070417000101 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 1951391960 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hannibal Regional Healthcare System IncGroup PAC ID 1254236300, 256 clinicians

Practice addresses (Care Compare)

PO Box
Suite 1257
Hannibal, MO 63401-1257
Phone (573) 248-5460

Hospital & facility affiliations

  • Hannibal Regional Hospital Hospital, Hannibal, MO, CCN 260025

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C01442ARMDAnesthesiology Physician
209006952ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Hannibal Regional Healthcare System Inc CurrentSince Mar 27, 2007 Accepting new patients
St Luke'S Methodist Hospital Current Accepting new patients

Locations

6000 Hospital Dr
Hannibal, MO 63401
Phone (573) 248-5460

6000 Hospital Dr
#1257
Hannibal, MO 63401
Phone (573) 248-5460

6500 Hospital Dr
Hannibal, MO 63401
Phone (573) 629-3400

Interoperability endpoints

  • Direct secure messaging: cgraham890696@direct.unitypoint.org
  • FHIR API: https://fhir.fhirpoint.open.allscripts.com/fhirroute/open/10040602

Organizations & group practices 2

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": "1158105600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658102400000",
    "number": "1487759502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 HOSPITAL DR.",
            "address_2": "P.O. BOX 551",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634010551",
            "telephone_number": "573-248-5621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 HOSPITAL DR",
            "city": "HANNIBAL",
            "state": "MO",
            "postal_code": "634016887",
            "telephone_number": "573-248-5621",
            "fax_number": "573-248-5264"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3301 Broadway St",
            "address_purpose": "LOCATION",
            "city": "Quincy",
            "state": "IL",
            "postal_code": "623013713",
            "country_code": "US",
            "telephone_number": "217-222-6550 x3163",
            "fax_number": "217-277-2253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GRAHAM",
        "first_name": "COURTNEY",
        "middle_name": "R",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-13",
        "last_updated": "2022-07-18",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "AR",
            "license": "C01442",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209006952",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "146423",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "910840008",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hannibal, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2022; 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.