Individual provider Active NPI

Amanda Jernigan, CRNA

  • Certified Registered Nurse Anesthetist
  • Farmington, NM
National Provider Identifier
1669860441
Registry record updated Jul 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
CRNA-56272 Issued in NM
Practice address
801 W Maple St
Farmington, NM 87401-5630
Phone
(505) 609-2000
Fax
(505) 609-2259
NPI assigned
Jan 2, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 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 APN0000019375 TN
Certified Registered Nurse Anesthetist 367500000X CRNA-56272 NM Primary

Addresses

Primary practice location

801 W Maple St
Farmington, NM 87401-5630

Mailing address

PO Box 6210
Farmington, NM 87499-6210
Phone (505) 609-2258

Other practice location 1

Vanderbilt Medical Ctr
1211 Medical Center Drive
Nashville, TN 37232-0001
Phone (615) 322-5000

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150422002377 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 1850619875 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
American Anesthesiology of Tennessee PCGroup PAC ID 9931001922, 296 clinicians

Practice addresses (Care Compare)

10820 Parkside Dr
Knoxville, TN 37934-1956
Phone (865) 546-8040

9300 Park W Blvd
Knoxville, TN 37923-4301
Phone (865) 546-8040

Hospital & facility affiliations

  • Physicians Regional Medical Center Hospital, Powell, TN, CCN 440120

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CRNA-56272NMMDCertified Registered Nurse Anesthetist
APN0000019375TNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Resource Anesthesia, P.C. Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2021 Accepting new patients
American Anesthesiology of Tennessee, P.C. CurrentSince Dec 17, 2021 Accepting new patients
Integrated Anesthesia Services, PLC Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2018 Accepting new patients
Otolaryngology Head and Neck Surgery Associates CurrentSince Jul 1, 2021 Accepting new patients

Locations

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

4713 Papermill Dr
Ste 100
Knoxville, TN 37909
Phone (865) 851-7771

9430 Park West Blvd
Ste 320
Knoxville, TN 37923
Phone (615) 441-4477

144 Concord Rd
Knoxville, TN 37934

550 Fort Loudon Medical Center Dr
#C
Lenoir City, TN 37772

345 23rd Ave N
Ste 209
Nashville, TN 37203
Phone (615) 329-5060

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.

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": "1420156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563321600000",
    "number": "1669860441",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6210",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874996210",
            "telephone_number": "505-609-2258",
            "fax_number": "505-609-2259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 W MAPLE ST",
            "city": "FARMINGTON",
            "state": "NM",
            "postal_code": "874015630",
            "telephone_number": "505-609-2000",
            "fax_number": "505-609-2259"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "Vanderbilt Medical Ctr",
            "address_2": "1211 Medical Center Drive",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372320001",
            "country_code": "US",
            "telephone_number": "615-322-5000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JERNIGAN",
        "first_name": "AMANDA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-01-02",
        "last_updated": "2019-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "APN0000019375",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NM",
            "license": "CRNA-56272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Farmington, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.