NPIMap

Organization Active NPI

Modern Anesthesia Consultants, LLC

  • Certified Registered Nurse Anesthetist
  • Conway, AR
National Provider Identifier
1659976751
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
MODERN ANESTHESIA CONSULTANTS, LLC
Practice address
810 Merriman St
Conway, AR 72032-4436
Phone
(501) 329-3937
NPI assigned
Dec 4, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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

Authorized official

Name
Crystal D Gibson
Title
Ar/Credentialing Manager
Phone
(615) 620-2336

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

810 Merriman St
Conway, AR 72032-4436

Mailing address

PO Box 290342
Nashville, TN 37229-0342
Phone (615) 620-2320

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210113000481 AR Part B Supplier - Clinic/Group Practice 4981017902 Receives reassigned benefits from 8 practitioners
Practice locations: Conway, AR; Little Rock, AR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1607040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607040000000",
    "number": "1659976751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 290342",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372290342",
            "telephone_number": "615-620-2320",
            "fax_number": "615-620-2323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 MERRIMAN ST",
            "city": "CONWAY",
            "state": "AR",
            "postal_code": "720324436",
            "telephone_number": "501-329-3937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN ANESTHESIA CONSULTANTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-04",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A",
        "authorized_official_last_name": "GIBSON",
        "authorized_official_first_name": "CRYSTAL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "AR/CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "615-620-2336"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Conway, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.