Active NPI
Tony Lee Sistrunk, CRNA
- Certified Registered Nurse Anesthetist
- Jackson, MS
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 901891
- Practice address
- 2500 N State St
Jackson, MS 39216-4500 - Phone
- (601) 815-2005
- NPI assigned
- Jan 26, 2024
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 901891 | MS | Primary |
Addresses
Primary practice location
2500 N State St
Jackson, MS 39216-4500
Mailing address
504 Clinton Center Drive
Cbo Suite 4300
Clinton, MS 39056
Phone (601) 815-2005
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MS
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1030 River Oaks Dr
Flowood, MS 39232-9553
Phone (601) 932-1030
2500 N State St
Jackson, MS 39216-4500
Phone (601) 815-4775
Hospital & facility affiliations
- University of Mississippi Med Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 901891 | MS | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anesthesia Consultants PA | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| State of Mississippi - University of Mississippi Medical Center | Current | Accepting new patients | |
| State of Mississippi-University of Mississippi Medical Center | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| State of Mississippi - University of Mississippi Medical Center | Current | Accepting new patients |
Locations
504 Clinton Center Dr
Ste 4300
Clinton, MS 39056
1030 River Oaks Dr
Jackson, MS 39232
Phone (601) 376-2165
2500 N State St
Jackson, MS 39216
Phone (601) 815-4775
2100 Highway 61 N
Vicksburg, MS 39183
Phone (601) 883-5001
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.
-
- Anesthesiology Physician
- Jackson, MS
- NPI 1750300836
Nurse Anesthetist, Certified Registered
-
- General Acute Care Hospital
- Jackson, MS
- NPI 1154317527
-
- Prosthetic/Orthotic Supplier
- Jackson, MS
- NPI 1235019530
-
- Nurse Practitioner
- Jackson, MS
- NPI 1699857433
Nurse Anesthetist, Certified Registered
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Jackson, MS
- NPI 1154317527
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706227200000",
"number": "1740042589",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "504 CLINTON CENTER DRIVE",
"address_2": "CBO SUITE 4300",
"city": "CLINTON",
"state": "MS",
"postal_code": "39056",
"telephone_number": "601-815-2005"
},
{
"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": "601-815-2005"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SISTRUNK",
"first_name": "TONY",
"middle_name": "LEE",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-26",
"last_updated": "2024-01-26",
"certification_date": "2024-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MS",
"license": "901891",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
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 Jan 26, 2024; 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.