Individual provider Active NPI

Michael Shawn Gaddy, CRNA

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
National Provider Identifier
1518994516
Registry record updated Jun 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
149472 Issued in NC
Practice address
1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone
(704) 355-8983
Fax
(704) 355-8994
NPI assigned
Jun 26, 2006
Last updated
Jun 28, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2010

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 149472 NC Primary

Addresses

Primary practice location

1000 Blythe Blvd
Charlotte, NC 28203-5812

Mailing address

PO Box 32861
Anesthesia SVCS - 5TH Floor Surgery Tower
Charlotte, NC 28232-2861
Phone (704) 355-8983

Other identifiers 2

IdentifierTypeStateIssuer
8052224MedicaidNC
NAN694MedicaidSC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041004000934 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 2668431941 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
CHS Anesthesia Services Group IncGroup PAC ID 5799007324, 742 clinicians

Practice addresses (Care Compare)

1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone (704) 355-2000

8800 N Tryon St
Charlotte, NC 28262-3300
Phone (704) 863-6000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
149472NCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
East Carolina Anesthesia Associates, PLLC Nurse Anesthetist, Certified Registered CurrentSince Jul 15, 2019 Accepting new patients
CHS Anesthesia Services Group Inc CurrentSince Sep 1, 2017 Accepting new patients
The Presbyterian Hospital Nurse Anesthetist, Certified Registered CurrentSince Mar 31, 2011 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Current Accepting new patients
The Presbyterian Hospital CurrentSince Mar 31, 2011 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Mar 7, 2015 Accepting new patients
The Charlotte-Mecklenburg Hospital Authority CurrentSince Mar 7, 2015 Accepting new patients
Mercy Hospital, Inc. Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

200 Hawthorne Ln
Charlotte, NC 28204
Phone (704) 377-2424

2825 Randolph Rd
Charlotte, NC 28211
Phone (704) 377-1647

2430 Emerald Pl
Ste 103
Greenville, NC 27834
Phone (252) 752-2140

433 McAlister Rd
Lincolnton, NC 28092
Phone (704) 512-7000

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

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": "1151280000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277683200000",
    "number": "1518994516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32861",
            "address_2": "ANESTHESIA SVCS - 5TH FLOOR SURGERY TOWER",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282322861",
            "telephone_number": "704-355-8983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-355-8983",
            "fax_number": "704-355-8994"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GADDY",
        "first_name": "MICHAEL",
        "middle_name": "SHAWN",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-26",
        "last_updated": "2010-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "149472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8052224",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NAN694",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2010; 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.