Individual provider Active NPI

Clarence E Patty, CRNA

  • Certified Registered Nurse Anesthetist
  • Murray, KY
National Provider Identifier
1497782122
Registry record updated Jan 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1091729 Issued in KY
Practice address
803 Poplar St
Murray, KY 42071-2432
Phone
(270) 762-1100
NPI assigned
Jun 27, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2014

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 1091729 KY Primary

Addresses

Primary practice location

803 Poplar St
Murray, KY 42071-2432

Mailing address

744 W Michigan Ave
Jackson, MI 49201-1909
Phone (517) 787-6440

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031219000006 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 7214834985 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tas of Kentucky LLCGroup PAC ID 3274856232, 8 clinicians

Practice addresses (Care Compare)

1099 Medical Ctr Cir
Mayfield, KY 42066-1179
Phone (270) 251-4100

Hospital & facility affiliations

  • Jackson Purchase Medical Center Hospital, Mayfield, KY, CCN 180116

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1091729KYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Tas of Kentucky LLC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2014 Accepting new patients
Trigg County Hospital, Inc Nurse Anesthetist, Certified Registered CurrentSince Feb 19, 2019 Accepting new patients
Murray Anesthetists Group, PLLC Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2016 Accepting new patients
Trigg County Hospital, Inc CurrentSince Feb 19, 2019 Accepting new patients
Northstar Anesthesia of Kentucky, PLLC Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2011 Accepting new patients
Murray Anesthesia Group, PLLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Jonesboro Anesthesia Inc Past Accepting new patients
Tas of Illinois, LLC Nurse Anesthetist, Certified Registered PastSince Jan 14, 2024 Accepting new patients

Locations

254 Main St
Cadiz, KY 42211
Phone (270) 522-3215

1099 Medical Center Cir
Mayfield, KY 42066
Phone (270) 251-4100

803 Poplar St
Murray, KY 42071
Phone (270) 762-1155

1000 Breckenridge St
Ste 100
Owensboro, KY 42303
Phone (270) 683-2751

1201 Pleasant Valley Rd
Owensboro, KY 42303
Phone (270) 417-2000

Organizations & group practices 8

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": "1151366400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1390435200000",
    "number": "1497782122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "744 W MICHIGAN AVE",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492011909",
            "telephone_number": "517-787-6440",
            "fax_number": "517-787-4146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "803 POPLAR ST",
            "city": "MURRAY",
            "state": "KY",
            "postal_code": "420712432",
            "telephone_number": "270-762-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PATTY",
        "first_name": "CLARENCE",
        "middle_name": "E",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-27",
        "last_updated": "2014-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "1091729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2014; 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.