NPIMap

Organization Active NPI

Legacy Anesthesia

  • Certified Registered Nurse Anesthetist
  • Lenoir City, TN
National Provider Identifier
1710499561
Registry record updated Jan 24, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
LEGACY ANESTHESIA
Practice address
12186 Paw Paw Plains Rd
Lenoir City, TN 37771-3510
Phone
(423) 639-0941
Fax
(423) 638-3401
NPI assigned
Nov 2, 2017
Last updated
Jan 24, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 24, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Richard Duane Deindoerfer, CRNANPI 1386789642
Title
Owner
Phone
(423) 639-0941

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X NU Primary

Addresses

Primary practice location

12186 Paw Paw Plains Rd
Lenoir City, TN 37771-3510

Mailing address

12186 Paw Paw Plains Rd
Lenoir City, TN 37771-3510
Phone (423) 639-0941

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180623000193 TN Part B Supplier - Clinic/Group Practice 7113272634 Receives reassigned benefits from 12 practitioners
Practice locations: Powell, TN

National Provider Directory

National Provider Directory

Locations

7739 Dannaher Dr
Powell, TN 37849
Phone (865) 339-4200

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1516752000000",
    "number": "1710499561",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12186 PAW PAW PLAINS RD",
            "city": "LENOIR CITY",
            "state": "TN",
            "postal_code": "377713510",
            "telephone_number": "423-639-0941",
            "fax_number": "423-638-3401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12186 PAW PAW PLAINS RD",
            "city": "LENOIR CITY",
            "state": "TN",
            "postal_code": "377713510",
            "telephone_number": "423-639-0941",
            "fax_number": "423-638-3401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY ANESTHESIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-02",
        "last_updated": "2018-01-24",
        "status": "A",
        "authorized_official_last_name": "DEINDOERFER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "DUANE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "423-639-0941",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lenoir City, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 24, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.