Individual provider Active NPI

Jessica Anne Egnor

  • Certified Registered Nurse Anesthetist
  • South Charleston, WV
National Provider Identifier
1740922863
Registry record updated Jun 20, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
119870 Issued in WV
Practice address
100 Angus E Peyton Dr
South Charleston, WV 25303-1600
Phone
(615) 545-6495
NPI assigned
Apr 9, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 84457 WV
Certified Registered Nurse Anesthetist 367500000X 119870 WV Primary

Addresses

Primary practice location

100 Angus E Peyton Dr
South Charleston, WV 25303-1600

Mailing address

307 Fairview Dr
Hurricane, WV 25526-1711
Phone (615) 545-6495

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Charleston Direct Marshall University

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240726000428 WV Practitioner - Certified Registered Nurse Anesthetist (Crna) 1951847953 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northstar Anesthesia of West Virginia PLLCGroup PAC ID 2668750241, 124 clinicians

Practice addresses (Care Compare)

1340 Hal Greer Blvd
Huntington, WV 25701-3804
Phone (304) 526-2000

Hospital & facility affiliations

  • Cabell Huntington Hospital, Inc Hospital, Huntington, WV, CCN 510055

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
84457WVMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Northstar Anesthesia of West Virginia, PLLC Nurse Anesthetist, Certified Registered CurrentSince Jun 18, 2024 Accepting new patients

Locations

13500 Powers Ct
Ste 230
Fort Myers, FL 33912
Phone (239) 610-0784

1340 Hal Greer Blvd
Huntington, WV 25701
Phone (304) 399-2960

Organizations & group practices 1

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": "1649462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1718841600000",
    "number": "1740922863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 FAIRVIEW DR",
            "city": "HURRICANE",
            "state": "WV",
            "postal_code": "255261711",
            "telephone_number": "615-545-6495"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 ANGUS E PEYTON DR",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253031600",
            "telephone_number": "615-545-6495"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EGNOR",
        "first_name": "JESSICA",
        "middle_name": "ANNE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-04-09",
        "last_updated": "2024-06-20",
        "certification_date": "2024-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "WV",
            "license": "84457",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WV",
            "license": "119870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Charleston",
            "affiliation": "Y",
            "endpointDescription": "marshall university",
            "affiliationName": "Marshall University",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "100 Angus E Peyton Dr",
            "city": "South Charleston",
            "state": "WV",
            "country_code": "US",
            "postal_code": "253031600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in South Charleston, WV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.

Verify at the official NPI Registry.