NPIMap

Individual provider Active NPI

Marissa Ann Hewitt, CRNA

  • Certified Registered Nurse Anesthetist
  • Bountiful, UT
National Provider Identifier
1750434981
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
309002-4406 Issued in UT
Practice address
630 Medical Dr
Bountiful, UT 84010-4908
Phone
(801) 299-2276
NPI assigned
Jan 19, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 309002-4406 UT Primary

Addresses

Primary practice location

630 Medical Dr
Bountiful, UT 84010-4908

Mailing address

1586 E Millbrook Way
Bountiful, UT 84010-1530
Phone (801) 298-3220

Other identifiers 2

IdentifierTypeStateIssuer
529910998001MedicaidUT
30900244000001OtherUTBLUE CROSS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, CO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20090217000350 UT Practitioner - Certified Registered Nurse Anesthetist (Crna) 6305813072 Reassigns benefits to 1 organization
I20240130001024 CO Practitioner - Certified Registered Nurse Anesthetist (Crna) 6305813072 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Community Medical Group LLCGroup PAC ID 1052612785, 109 clinicians

Practice addresses (Care Compare)

2373 G Rd
Suite 280
Grand Junction, CO 81505-1006
Phone (970) 644-4030

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
0 of 100Reported as group
Quality
0
Promoting interoperability
0
Improvement activities
0
Cost
0

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
309002-4406UTMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Medical Group, LLC Current Accepting new patients
Community Medical Group, LLC CurrentSince Dec 1, 2023 Accepting new patients
Ecgj Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2024 Accepting new patients
Community Medical Group, LLC CurrentSince Dec 1, 2023 Accepting new patients

Locations

688 23 12 Rd Ste 303 Apccgv
Grand JCT, CO 81505

1035 Wellington Ave
Grand Junction, CO 81501
Phone (970) 242-6600

2373 G Rd
Ste 160
Grand Junction, CO 81505
Phone (970) 263-2680

2373 G Rd
Ste 280
Grand Junction, CO 81505
Phone (970) 243-9343

225 Eagle Crest Dr
Rangely, CO 81648
Phone (970) 675-4253

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

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": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1750434981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1586 E MILLBROOK WAY",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840101530",
            "telephone_number": "801-298-3220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 MEDICAL DR",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840104908",
            "telephone_number": "801-299-2276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HEWITT",
        "first_name": "MARISSA",
        "middle_name": "ANN",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "UT",
            "license": "309002-4406",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529910998001",
            "state": "UT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "30900244000001",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bountiful, UT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.