NPIMap

Individual provider Active NPI

Amanda H Bagwell, CRNA

  • Certified Registered Nurse Anesthetist
  • Tupelo, MS
National Provider Identifier
1710176532
Registry record updated Apr 24, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R867411 Issued in MS
Practice address
830 South Gloster
Tupelo, MS 38801
Phone
(662) 377-4394
Fax
(662) 377-7045
NPI assigned
Oct 17, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 24, 2009

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 R867411 MS Primary

Addresses

Primary practice location

830 South Gloster
Tupelo, MS 38801

Mailing address

PO Box 3294
Tupelo, MS 38803-3294
Phone (662) 377-4394

Other names 1

  • Amanda L Hoffman Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080211000011 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 7719060003 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Lifelinc Anesthesia PLLC 169 clinicians
North Mississippi Medical Center, Inc. 361 clinicians

Practice addresses (Care Compare)

200 State Hwy 30 W
New Albany, MS 38652-3112
Phone (662) 538-7631

830 S Gloster
North Ms Med Ctr Sleep Lab
Tupelo, MS 38801-4934
Phone (662) 377-3258

830 S Gloster St
Tupelo, MS 38801-4934

830 S Gloster St 3Rd FL E Tower
Tupelo, MS 38801-4934

Hospital & facility affiliations

  • Baptist Memorial Hospital Union County Hospital, New Albany, MS, CCN 250006
  • North Mississippi Medical Center Hospital, Tupelo, MS, CCN 250004

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
North Mississippi Medcial Center, Inc. CurrentSince Oct 1, 2007 Accepting new patients
DHS Anesthesia, LLC CurrentSince Nov 20, 2017 Accepting new patients
Tupelo Anesthesia Group PA CurrentSince Oct 1, 2007 Accepting new patients
Lifelinc Anesthesia, PLLC Nurse Anesthetist, Certified Registered CurrentSince Mar 16, 2024 Accepting new patients
North Mississippi Medical Center CurrentSince Oct 1, 2007 Accepting new patients
North Mississippi Medical Center Inc Current Accepting new patients

Locations

634 Leigh Dr
Columbus, MS 39705
Phone (601) 978-3393

200 State Highway 30 W
New Albany, MS 38652
Phone (601) 534-7631

1100 Belk Blvd
Oxford, MS 38655
Phone (662) 636-1000

589 Garfield St
Tupelo, MS 38801
Phone (601) 680-5565

830 S Gloster St
Tupelo, MS 38801
Phone (662) 377-3136

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 2

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": "1192579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1240531200000",
    "number": "1710176532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3294",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388033294",
            "telephone_number": "662-377-4394",
            "fax_number": "662-377-7045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 SOUTH GLOSTER",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "38801",
            "telephone_number": "662-377-4394",
            "fax_number": "662-377-7045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGWELL",
        "first_name": "AMANDA",
        "middle_name": "H",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-17",
        "last_updated": "2009-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "R867411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "HOFFMAN",
            "middle_name": "L",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2009; 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.