Individual provider Active NPI

Jeremy Fendley, CRNA

  • Certified Registered Nurse Anesthetist
  • Germantown, TN
National Provider Identifier
1700830544
Registry record updated Jun 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
APN 10544 Issued in TN
Practice address
1900 Exeter Rd
Suite 210
Germantown, TN 38138-2954
Phone
(901) 818-2160
Fax
(901) 682-9522
NPI assigned
May 19, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 9, 2011

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 APN 10544 TN Primary
Registered Nurse 163W00000X RN 147039 TN

Addresses

Primary practice location

1900 Exeter Rd
Suite 210
Germantown, TN 38138-2954

Mailing address

1900 Exeter Rd
Suite 210
Germantown, TN 38138-2954
Phone (901) 818-2160

Other identifiers 6

IdentifierTypeStateIssuer
4098869OtherTNBLUE CROSS
P00178338OtherTNRAILROAD MEDICARE
08152327MedicaidMS
161283001MedicaidAR
83990OtherARBLUE CROSS
3634116MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050124000773 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 7214905496 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Virginia Commonwealth University, School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ut Regional One Physicians IncGroup PAC ID 5698993418, 314 clinicians

Practice addresses (Care Compare)

877 Jefferson Ave
Memphis, TN 38103-2807
Phone (901) 545-8336

Hospital & facility affiliations

  • Regional One Health Hospital, Memphis, TN, CCN 440152

Merit-based Incentive Payment System (MIPS)

Final score
80.97 of 100Reported as group
Quality
64.58
Improvement activities
40
Cost
77.33

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
10544TNMDGeneral Practice Dentistry
RN 147039TNMDRegistered Nurse
APN 10544TNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Ut Regional One Physicians Inc Nurse Anesthetist, Certified Registered CurrentSince Mar 2, 2020 Accepting new patients
Ut Regional One Physicians Inc Nurse Anesthetist, Certified Registered Current Accepting new patients
American Anesthesiology of Tennessee, P.C. Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2015 Accepting new patients
American Anesthesiology of Tennessee, P.C. CurrentSince Jan 1, 2015 Accepting new patients

Locations

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

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

877 Jefferson Ave
Memphis, TN 38103
Phone (901) 448-5893

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": "1147996800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1307577600000",
    "number": "1700830544",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 EXETER RD",
            "address_2": "SUITE 210",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382954",
            "telephone_number": "901-818-2160",
            "fax_number": "901-682-9522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 EXETER RD",
            "address_2": "SUITE 210",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382954",
            "telephone_number": "901-818-2160",
            "fax_number": "901-682-9522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FENDLEY",
        "first_name": "JEREMY",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-05-19",
        "last_updated": "2011-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "APN 10544",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "RN 147039",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "4098869",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00178338",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08152327",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "161283001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "83990",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3634116",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Germantown, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2011; 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.