NPIMap

Individual provider Active NPI

Jeremy Gormly, CRNA

  • Certified Registered Nurse Anesthetist
  • Sulphur, LA
National Provider Identifier
1689930836
Registry record updated Jan 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
AP06850 Issued in LA
Practice address
701 Cypress St
Sulphur, LA 70663-5053
Phone
(337) 842-5973
NPI assigned
Apr 2, 2012
Last updated
Jan 22, 2020By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2020

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 AP06850 LA Primary
Registered Nurse 163W00000X RN122569 LA

Addresses

Primary practice location

701 Cypress St
Sulphur, LA 70663-5053

Mailing address

434 Crestwood St
Lake Charles, LA 70605-6820

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121018000221 LA Practitioner - Certified Registered Nurse Anesthetist (Crna) 9335399831 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Youngs Professional Services LLCGroup PAC ID 2163524992, 297 clinicians
Lake Charles Anesthesiology, ApmcGroup PAC ID 6800867714, 25 clinicians

Practice addresses (Care Compare)

501 Doctor Michael Debakey Dr
Lake Charles, LA 70601-5724
Phone (337) 433-8400

524 Doctor Michael Debakey Dr
Lake Charles, LA 70601-5725
Phone (337) 436-2511

701 Cypress St
Sulphur, LA 70663-5053
Phone (337) 527-6530

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
RN122569LAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Osc Anesthesia, LLC Single Specialty CurrentSince Feb 1, 2025 Accepting new patients
Calcasieu Cameron Hospital Service District Single Specialty Current Accepting new patients
Calcasieu Cameron Hospital Service District Single Specialty CurrentSince Feb 1, 2020 Accepting new patients
Christus Surgery Center Villages LLC Current Accepting new patients
Calcasieu Cameron Hospital Service District Single Specialty CurrentSince Feb 1, 2020 Accepting new patients
Youngs Professional Services LLC Single Specialty CurrentSince Aug 1, 2024 Accepting new patients

Locations

1020 Main St
Hackberry, LA 70645
Phone (337) 762-3762

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

501 Dr Michael Debakey Dr
Lake Charles, LA 70601
Phone (337) 312-8258

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

385 Bert Kouns Loop
Ste 300
Shreveport, LA 71106
Phone (318) 212-0552

701 Cypress St
Sulphur, LA 70663
Phone (337) 527-4270

Organizations & group practices 7

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 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1333324800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1579651200000",
    "number": "1689930836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "434 CRESTWOOD ST",
            "city": "LAKE CHARLES",
            "state": "LA",
            "postal_code": "706056820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 CYPRESS ST",
            "city": "SULPHUR",
            "state": "LA",
            "postal_code": "706635053",
            "telephone_number": "337-842-5973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORMLY",
        "first_name": "JEREMY",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-04-02",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "LA",
            "license": "AP06850",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "LA",
            "license": "RN122569",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sulphur, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; 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.