Individual provider Active NPI

Danielle Jo Moore, CRNA

  • Certified Registered Nurse Anesthetist
  • Newnan, GA
National Provider Identifier
1760789523
Registry record updated Apr 16, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN204956 Issued in GA
Practice address
80 Newnan Station Drive, Suite a
Newnan, GA 30265
Phone
(770) 251-2060
Fax
(678) 854-9235
NPI assigned
Feb 14, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2015

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 RN204956 GA Primary

Addresses

Primary practice location

80 Newnan Station Drive, Suite a
Newnan, GA 30265

Mailing address

PO Box 73709
Newnan, GA 30271-3709
Phone (770) 251-2060

Other names 1

  • Danielle Jo Larson Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110308000388 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 3971785254 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Medical University of South Carolina College of Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sentry Anesthesia Management, LLCGroup PAC ID 9436372323, 170 clinicians

Practice addresses (Care Compare)

126 US Hwy 280 W
Americus, GA 31719-8645
Phone (229) 924-6011

600 Celebrate Life Pkwy
Newnan, GA 30265-8001
Phone (770) 400-7016

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN204956GAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Sentry Anesthesia Management, LLC CurrentSince May 2, 2014 Accepting new patients
Southern Crescent Anesthesiology, PC Nurse Anesthetist, Certified Registered CurrentSince Jan 31, 2011 Accepting new patients
City of Hope Medical Group of Georgia LLC Past Accepting new patients

Locations

126 US Highway 280 W
Americus, GA 31719
Phone (229) 924-6011

3200 Downwood Cir NW
Ste 200
Atlanta, GA 30327
Phone (404) 351-1990

7351 Old Moon Rd
Columbus, GA 31909
Phone (706) 221-2721

601 S 8th St
Griffin, GA 30224
Phone (770) 228-2721

1514 Vernon Rd
Lagrange, GA 30240
Phone (706) 812-2369

600 Celebrate Life Pkwy
Newnan, GA 30265
Phone (404) 844-8334

80 Newnan Station Dr
Ste A
Newnan, GA 30265

3150 Highway 34 E
Ste 195
Newnan, GA 30265

3025 Sharpsburg McCullum Rd
Unit B
Newnan, GA 30265

3150 Highway 34 E
Newnan, GA 30265
Phone (770) 254-3035

3150 Highway 34 E
#195
Newnan, GA 30265

Organizations & group practices 3

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": "1297641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1429142400000",
    "number": "1760789523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 73709",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "302713709",
            "telephone_number": "770-251-2060",
            "fax_number": "678-854-9235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 NEWNAN STATION DRIVE, SUITE A",
            "city": "NEWNAN",
            "state": "GA",
            "postal_code": "30265",
            "telephone_number": "770-251-2060",
            "fax_number": "678-854-9235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOORE",
        "first_name": "DANIELLE",
        "middle_name": "JO",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-02-14",
        "last_updated": "2015-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN204956",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANIELLE",
            "last_name": "LARSON",
            "middle_name": "JO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Newnan, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2015; 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.