NPIMap

Organization Active NPI

Smokey Mountain Anesthesia PC

  • Certified Registered Nurse Anesthetist
  • Johnson City, TN
National Provider Identifier
1538196829
Registry record updated Jan 11, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
SMOKEY MOUNTAIN ANESTHESIA PC
Practice address
110 Med Tech Pkwy
Johnson City, TN 37604-4004
Phone
(423) 722-0371
NPI assigned
Jun 26, 2006
Last updated
Jan 11, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2022

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

Authorized official

Name
Mr. James Root, CRNANPI 1720071756
Title
Managing Partner
Phone
(423) 967-3436

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

110 Med Tech Pkwy
Johnson City, TN 37604-4004

Mailing address

PO Box 5665
Johnson City, TN 37602-5665
Phone (423) 639-0941

Other identifiers 1

IdentifierTypeStateIssuer
3723481MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031118000489 TN Part B Supplier - Clinic/Group Practice 0749194363 Receives reassigned benefits from 10 practitioners
Practice locations: Johnson City, TN

National Provider Directory

National Provider Directory

Locations

110 Med Tech Pkwy
Johnson City, TN 37604
Phone (423) 722-0371

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1151280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641859200000",
    "number": "1538196829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5665",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376025665",
            "telephone_number": "423-639-0941"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 MED TECH PKWY",
            "city": "JOHNSON CITY",
            "state": "TN",
            "postal_code": "376044004",
            "telephone_number": "423-722-0371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SMOKEY MOUNTAIN ANESTHESIA PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-26",
        "last_updated": "2022-01-11",
        "certification_date": "2022-01-11",
        "status": "A",
        "authorized_official_last_name": "ROOT",
        "authorized_official_first_name": "JAMES",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "423-967-3436",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3723481",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnson City, TN

Sources for this page

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