Individual provider Active NPI

Jared L Collins, CRNA

  • Certified Registered Nurse Anesthetist
  • Gastonia, NC
National Provider Identifier
1619448560
Registry record updated Jul 19, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
124305 Issued in NC
Practice address
2525 Court Dr
Gastonia, NC 28054-2140
Phone
(704) 834-2000
NPI assigned
Dec 17, 2018
Last updated
Jul 19, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 19, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 124305 NC Primary
Registered Nurse 163W00000X 286033 NC

Addresses

Primary practice location

2525 Court Dr
Gastonia, NC 28054-2140

Mailing address

2525 Court Dr
Gastonia, NC 28054-2140
Phone (704) 864-8772

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190201002382 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 3678810389 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
East Carolina Anesthesia Associates PLLCGroup PAC ID 5092720813, 691 clinicians

Practice addresses (Care Compare)

2525 Court Dr
Gastonia, NC 28054-2140
Phone (704) 834-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
124305NCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
East Carolina Anesthesia Associates, PLLC Registered Nurse CurrentSince Jan 7, 2019 Accepting new patients
CHS Anesthesia Services Group Inc Anesthesiology CurrentSince Apr 1, 2020 Accepting new patients

Locations

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

2001 Vail Ave
Charlotte, NC 28207
Phone (704) 304-5000

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

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

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

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": "1545004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563494400000",
    "number": "1619448560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2525 COURT DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542140",
            "telephone_number": "704-864-8772",
            "fax_number": "704-866-7853"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 COURT DR",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280542140",
            "telephone_number": "704-834-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS",
        "first_name": "JARED",
        "middle_name": "L",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-17",
        "last_updated": "2019-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "124305",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NC",
            "license": "286033",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2019; 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.