Individual provider Active NPI

Mackenzie Gannon Acosta, CRNA

  • Certified Registered Nurse Anesthetist
  • Jackson, MS
National Provider Identifier
1699472928
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
901835 Issued in MS
Practice address
2500 N State St
Jackson, MS 39216-4500
Phone
(601) 984-1000
NPI assigned
Feb 7, 2023
Last updated
Sep 25, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 25, 2023

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 901835 MS Primary

Addresses

Primary practice location

2500 N State St
Jackson, MS 39216-4500

Mailing address

504 Clinton Center Dr Ste 4300
Clinton, MS 39056-5610
Phone (601) 496-9524

Other names 1

  • Mackenzie G Acosta Professional name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, TN, KY3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20230428001871 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 4981069820 Reassigns benefits to 3 organizations
I20241115002835 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 4981069820 Reassigns benefits to 1 organization
I20260304000628 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 4981069820 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Resource Anesthesiology Associates of TN PCGroup PAC ID 8527419092, 145 clinicians
Professional Anesthesia Services of Kentucky PLLCGroup PAC ID 0244590305, 351 clinicians

Practice addresses (Care Compare)

1265 Union Ave
Suite 201
Memphis, TN 38104-3415
Phone (901) 516-7000

200 E Chestnut St
Louisville, KY 40202-1831
Phone (502) 629-8000

3960 New Covington Pike
Memphis, TN 38128-2504
Phone (901) 516-5200

4000 Kresge Way
Louisville, KY 40207-4605
Phone (502) 897-8100

4250 Bethel Rd
Olive Branch, MS 38654-8737
Phone (662) 932-9000

7691 Poplar Ave
Germantown, TN 38138-3904
Phone (901) 516-6000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
83.94 of 100Reported as group
Quality
67.75
Promoting interoperability
100
Improvement activities
40
Cost
71.17

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
35688TNMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
State of Mississippi - University of Mississippi Medical Center Current Accepting new patients
State of Mississippi - University of Mississippi Medical Center CurrentSince Feb 12, 2023 Accepting new patients
Resource Anesthesiology Associates of TN PC Nurse Anesthetist, Certified Registered CurrentSince Feb 9, 2024 Accepting new patients
Physicians Anesthesia Group, P.a. CurrentSince Sep 16, 2023 Accepting new patients
State of Mississippi-University of Mississippi Medical Center CurrentSince Feb 12, 2023 Accepting new patients
Professional Anesthesia Services of Kentucky PLLC Nurse Anesthetist, Certified Registered CurrentSince Jan 29, 2026 Accepting new patients

Locations

504 Clinton Center Dr
Ste 4300
Clinton, MS 39056

2500 N State St
Jackson, MS 39216
Phone (601) 815-4775

971 Lakeland Dr
Jackson, MS 39216
Phone (601) 939-5922

239 Bowling Green Rd
Lexington, MS 39095
Phone (662) 834-1321

4250 Bethel Rd
Olive Branch, MS 38654
Phone (662) 932-9000

450 Mamaroneck Ave
Ste 201
Harrison, NY 10528
Phone (877) 476-6642

1265 Union Ave
Memphis, TN 38104
Phone (901) 516-2362

1265 Union Ave
Ste 201
Memphis, TN 38104
Phone (901) 516-7000

1300 Wesley Dr
Memphis, TN 38116
Phone (901) 516-3700

3960 New Covington Pike
Memphis, TN 38128
Phone (901) 516-5200

7691 Poplar Ave
Memphis, TN 38138
Phone (901) 516-1290

Organizations & group practices 6

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 4

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": "1675728000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695600000000",
    "number": "1699472928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "504 CLINTON CENTER DR STE 4300",
            "city": "CLINTON",
            "state": "MS",
            "postal_code": "390565610",
            "telephone_number": "601-496-9524",
            "fax_number": "601-815-0434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 N STATE ST",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164500",
            "telephone_number": "601-984-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ACOSTA",
        "first_name": "MACKENZIE",
        "middle_name": "GANNON",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-02-07",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "901835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MACKENZIE",
            "last_name": "ACOSTA",
            "middle_name": "G",
            "credential": "CRNA",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; 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.