Individual provider Active NPI

Harold J Grissom, CRNA

  • Certified Registered Nurse Anesthetist
  • Columbus, MS
National Provider Identifier
1578740205
Registry record updated May 13, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R857989 Issued in MS
Practice address
2520 5TH St N
Columbus, MS 39705-2008
Phone
(662) 244-1000
Fax
(662) 327-6004
NPI assigned
Jan 24, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 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 R857989 MS Primary

Addresses

Primary practice location

2520 5TH St N
Columbus, MS 39705-2008

Mailing address

29 Creamery LN
Easton, MD 21601-3137
Phone (800) 222-1335

Other identifiers 2

IdentifierTypeStateIssuer
149323637OtherMSTRI-CARE
04438041MedicaidMS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101207000252 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 1658568407 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
State of Mississippi - University of Mississippi Medical CenterGroup PAC ID 1850293036, shared by 23 NPIs, 956 clinicians
Baptist Memorial Hospital - Golden Triangle IncGroup PAC ID 1456244623, 27 clinicians

Practice addresses (Care Compare)

2500 N State St
Jackson, MS 39216-4500
Phone (601) 815-4775

2520 5TH St N
BMH Golden Triangle
Columbus, MS 39705-2008
Phone (662) 244-1000

Hospital & facility affiliations

  • BMH-Golden Triangle Hospital, Columbus, MS, CCN 250100

Merit-based Incentive Payment System (MIPS)

Final score
96.17 of 100Reported as group
Quality
88.62
Promoting interoperability
100
Improvement activities
40
Cost
77.86

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Gac Anesthesia, LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 21, 2023 Accepting new patients
Baptist Memorial Hospital - Golden Triangle Inc. CurrentSince Jun 2, 2010 Accepting new patients
Boa Vida Hospital of Aberdeen, Ms LLC CurrentSince Sep 14, 2019 Accepting new patients
Boa Vida Hospital of Aberdeen, Ms, LLC CurrentSince Sep 14, 2019 Accepting new patients
Baptist Memorial Hospital - Golden Triangle Inc. CurrentSince Jun 2, 2010 Accepting new patients
Boa Vida Hospital of Aberdeen, Ms, LLC Past Accepting new patients

Locations

29 Creamery Ln
Easton, MD 21601
Phone (410) 924-7912

400 S Chestnut St
Aberdeen, MS 39730
Phone (662) 369-2455

2520 5th St N
Columbus, MS 39705
Phone (662) 224-1000

600 Leigh Dr
Columbus, MS 39705
Phone (662) 327-7525

Organizations & group practices 6

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": "1201132800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1273708800000",
    "number": "1578740205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 CREAMERY LN",
            "city": "EASTON",
            "state": "MD",
            "postal_code": "216013137",
            "telephone_number": "800-222-1335",
            "fax_number": "800-222-1335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 5TH ST N",
            "city": "COLUMBUS",
            "state": "MS",
            "postal_code": "397052008",
            "telephone_number": "662-244-1000",
            "fax_number": "662-327-6004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GRISSOM",
        "first_name": "HAROLD",
        "middle_name": "J",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-01-24",
        "last_updated": "2010-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "R857989",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRI-CARE",
            "identifier": "149323637",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04438041",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Columbus, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 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.