Individual provider Active NPI

Thomas Jay Gifford, CRNA

  • Certified Registered Nurse Anesthetist
  • Mount Holly, NJ
National Provider Identifier
1669408639
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
26NO09501300 Issued in NJ
Practice address
120 Madison Ave
Suite D
Mount Holly, NJ 08060-2055
Phone
(609) 261-1660
NPI assigned
Jun 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 26NO09501300 NJ Primary

Addresses

Primary practice location

120 Madison Ave
Suite D
Mount Holly, NJ 08060-2055

Mailing address

255 W Michigan Ave
PO Box 1123
Jackson, MI 49201-2218
Phone (517) 787-6440

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180727001741 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 2668495706 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
26NO09501300NJMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
St. Lucie Anesthesia Associates, LLC CurrentSince May 1, 2019 Accepting new patients
St Lucie Anesthesia Associates LLC CurrentSince May 1, 2019 Accepting new patients
Treasure Coast Anesthesia Group PA Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2018 Accepting new patients
Burlington Anesthesia Associates, PA Past Accepting new patients

Locations

3995 NW Goldenrod Rd
Jensen Beach, FL 34957
Phone (772) 497-0020

10080 SW Innovation Way
Ste 101
Port St Lucie, FL 34987
Phone (561) 358-2445

1800 SE Tiffany Ave
Port St Lucie, FL 34952
Phone (772) 398-1969

509 SE Riverside Dr
Ste 100
Stuart, FL 34994
Phone (772) 223-5920

200 SE Hospital Ave
Stuart, FL 34994
Phone (772) 223-5618

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1669408639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W MICHIGAN AVE",
            "address_2": "PO BOX 1123",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012218",
            "telephone_number": "517-787-6440",
            "fax_number": "517-787-4146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 MADISON AVE",
            "address_2": "SUITE D",
            "city": "MOUNT HOLLY",
            "state": "NJ",
            "postal_code": "080602055",
            "telephone_number": "609-261-1660"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GIFFORD",
        "first_name": "THOMAS",
        "middle_name": "JAY",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NJ",
            "license": "26NO09501300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Holly, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.