Individual provider Active NPI

Damani Kobie Johnson, RN

  • Certified Registered Nurse Anesthetist
  • Memphis, TN
National Provider Identifier
1639655020
Registry record updated Feb 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
0000024814 Issued in TN
Practice address
1068 Cresthaven Rd Ste 150
Memphis, TN 38119-3859
Phone
(901) 412-4706
NPI assigned
Jul 18, 2018
Last updated
Feb 21, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 0000172873 TN
Certified Registered Nurse Anesthetist 367500000X 0000024814 TN Primary

Addresses

Primary practice location

1068 Cresthaven Rd Ste 150
Memphis, TN 38119-3859

Mailing address

1068 Cresthaven Rd Ste 150
Memphis, TN 38119-3859
Phone (901) 412-4706

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20181109002656 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 5092069013 Reassigns benefits to 3 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
Covenant Anesthesia Group PCGroup PAC ID 6901795830, 231 clinicians

Practice addresses (Care Compare)

1819 Clinch Ave
Suite 206
Knoxville, TN 37916-2435
Phone (865) 522-2949

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0000172873TNMDRegistered Nurse
24814TNMDEndocrinology, Diabetes & Metabolism Physician
0000024814TNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of Tennessee, P.C. Nurse Anesthetist, Certified Registered CurrentSince Mar 11, 2022 Accepting new patients
East Memphis Anesthesia Services PLC CurrentSince Aug 25, 2018 Accepting new patients
American Anesthesiology of Tennessee, P.C. CurrentSince Mar 11, 2022 Accepting new patients
Covenant Anesthesia Group, PC CurrentSince Jan 14, 2024 Accepting new patients

Locations

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

2986 Kate Bond Rd
Bartlett, TN 38133
Phone (901) 765-1000

1819 Clinch Ave
Ste 206
Knoxville, TN 37916
Phone (865) 522-2949

9300 Park West Blvd
Knoxville, TN 37923
Phone (865) 427-4040

Dept 888089
Knoxville, TN 37995

1068 Cresthaven Rd
Ste 150
Memphis, TN 38119
Phone (205) 789-5982

255 S Pauline St
Memphis, TN 38104
Phone (901) 261-2804

990 Oak Ridge Tpke
Oak Ridge, TN 37830
Phone (865) 481-1000

Organizations & group practices 4

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": "1531872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550707200000",
    "number": "1639655020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1068 CRESTHAVEN RD STE 150",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381193859",
            "telephone_number": "901-412-4706"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1068 CRESTHAVEN RD STE 150",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381193859",
            "telephone_number": "901-412-4706"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "DAMANI",
        "middle_name": "KOBIE",
        "name_prefix": "Mr.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-18",
        "last_updated": "2019-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "0000172873",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "0000024814",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Memphis, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 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.