Individual provider Active NPI

Mark Guidry, CRNA

  • Certified Registered Nurse Anesthetist
  • Knoxville, TN
National Provider Identifier
1679519748
Registry record updated Jul 12, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
11019 Issued in TN
Practice address
501 20TH St
Suite 606
Knoxville, TN 37916
Phone
(865) 546-8040
Fax
(865) 541-2787
NPI assigned
Jun 20, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 12, 2018

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 11019 TN Primary

Addresses

Primary practice location

501 20TH St
Suite 606
Knoxville, TN 37916

Mailing address

501 20TH St
Suite 606
Knoxville, TN 37916-1809
Phone (865) 546-8040

Other practice location 1

256 Fort Sanders West Blvd
Knoxville, TN 37922-3355
Phone (865) 244-4580

Other practice location 2

1901 Clinch Ave
Knoxville, TN 37916-2307
Phone (865) 541-1111

Other practice location 3

210 Fort Sanders West Blvd
Knoxville, TN 37922-3355
Phone (865) 531-5200

Other identifiers 5

IdentifierTypeStateIssuer
430057884OtherTNMEDICARE TRAVELERS
3902369MedicaidTN
4108667OtherTNBLUE CROSS
100031535OtherTNPHP TENNCARE
4108667OtherTNBLUECARE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, LA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20050728000420 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 2264334549 Reassigns benefits to 1 organization
I20210126000018 LA Practitioner - Certified Registered Nurse Anesthetist (Crna) 2264334549 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
LCMS Cardiovascular Diseases, LLCGroup PAC ID 1951541515, 34 clinicians

Practice addresses (Care Compare)

1701 Oak Park Blvd
Lake Charles, LA 70601-8911
Phone (337) 494-3255

Hospital & facility affiliations

  • Lake Charles Memorial Hospital Hospital, Lake Charles, LA, CCN 190060

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
LCMS Cardiovascular Diseases, LLC CurrentSince Oct 22, 2020 Accepting new patients
American Anesthesiology of Tennessee, P.C. CurrentSince Sep 18, 2000 Accepting new patients
Youngs Professional Services LLC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2023 Accepting new patients
American Anesthesiology of Tennessee, P.C. Nurse Anesthetist, Certified Registered CurrentSince Sep 18, 2000 Accepting new patients
Lake Charles Anesthesiology, Apmc CurrentSince Jul 10, 2023 Accepting new patients

Locations

1701 Oak Park Blvd
Lake Charles, LA 70601
Phone (337) 494-3000

524 Dr Michael Debakey Dr
Lake Charles, LA 70601
Phone (337) 430-4455

5150 Robotics Ln
Lake Charles, LA 70605
Phone (337) 214-1591

1900 W Gauthier Rd
Lake Charles, LA 70605
Phone (337) 480-7000

1100 Andre St
Ste 300
New Iberia, LA 70563
Phone (337) 364-9225

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

256 Fort Sanders West Blvd
Knoxville, TN 37922
Phone (865) 244-4580

1901 Clinch Ave
Knoxville, TN 37916
Phone (865) 331-1111

501 20th St
Ste 606
Knoxville, TN 37916
Phone (865) 331-2278

Organizations & group practices 5

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 3

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": "1150761600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1531353600000",
    "number": "1679519748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 20TH ST",
            "address_2": "SUITE 606",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379161809",
            "telephone_number": "865-546-8040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 20TH ST",
            "address_2": "SUITE 606",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "37916",
            "telephone_number": "865-546-8040",
            "fax_number": "865-541-2787"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "256 Fort Sanders West Blvd",
            "address_purpose": "LOCATION",
            "city": "Knoxville",
            "state": "TN",
            "postal_code": "379223355",
            "country_code": "US",
            "telephone_number": "865-244-4580",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1901 Clinch Ave",
            "address_purpose": "LOCATION",
            "city": "Knoxville",
            "state": "TN",
            "postal_code": "379162307",
            "country_code": "US",
            "telephone_number": "865-541-1111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "210 Fort Sanders West Blvd",
            "address_purpose": "LOCATION",
            "city": "Knoxville",
            "state": "TN",
            "postal_code": "379223355",
            "country_code": "US",
            "telephone_number": "865-531-5200",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GUIDRY",
        "first_name": "MARK",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-20",
        "last_updated": "2018-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "11019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE TRAVELERS",
            "identifier": "430057884",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3902369",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "4108667",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHP TENNCARE",
            "identifier": "100031535",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECARE",
            "identifier": "4108667",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2018; 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.