NPIMap

Individual provider Active NPI

Dana Nichole Davis, RN

  • Certified Registered Nurse Anesthetist
  • Germantown, TN
National Provider Identifier
1770827867
Registry record updated Oct 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
175063 Issued in TN
Practice address
1900 Exeter Rd
Suite 210
Germantown, TN 38138-2954
Phone
(662) 315-0843
Fax
(901) 682-9522
NPI assigned
Nov 15, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 17, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 175063 TN
Certified Registered Nurse Anesthetist 367500000X 90893 MS
Certified Registered Nurse Anesthetist 367500000X 175063 TN Primary

Addresses

Primary practice location

1900 Exeter Rd
Suite 210
Germantown, TN 38138-2954

Mailing address

1900 Exeter Rd
Suite 210
Germantown, TN 38138-2954
Phone (662) 315-0843

Other identifiers 4

IdentifierTypeStateIssuer
12518435MedicaidTN
1770827867OtherTNTRICARE/HUMANA/CHAMPUS
196343001MedicaidAR
4342060OtherTNBLUE CROSS OF TN

Other names 1

  • Miss Dana Nichole Ryan Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN, MS2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20130318000116 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 6204071418 Reassigns benefits to 1 organization
I20200225001648 MS Practitioner - Certified Registered Nurse Anesthetist (Crna) 6204071418 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Etas PLLCGroup PAC ID 8123481934, 43 clinicians

Practice addresses (Care Compare)

4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 867-4000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Registered Nurse

State licenses

LicenseStateTypeSpecialty
175063TNMDRegistered Nurse
90893MSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital at Gulfport CurrentSince Sep 27, 2023 Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients
Willow Anesthesia Services LLC Nurse Anesthetist, Certified Registered CurrentSince Feb 1, 2020 Accepting new patients
Magnolia State Anesthesia Services, PLLC CurrentSince Dec 7, 2023 Accepting new patients
Medical Anesthesia Group, PA CurrentSince Jul 1, 2016 Accepting new patients
Monroe Health Services, Inc. CurrentSince Feb 12, 2021 Accepting new patients
Etas, PLLC CurrentSince Nov 7, 2023 Accepting new patients
Memorial Hospital at Gulfport CurrentSince Sep 27, 2023 Accepting new patients
Monroe Health Services, Inc. CurrentSince Feb 12, 2021 Accepting new patients

Locations

7956 Vaughn Rd
Ste 165
Montgomery, AL 36116

1105 Earl Frye Blvd
Amory, MS 38821
Phone (662) 256-7111

960 Avent Dr
Grenada, MS 38901
Phone (662) 227-7000

1340 Broad Ave
Ste 440
Gulfport, MS 39501
Phone (228) 867-4856

4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872

2704 West Oxford Loop
Ste 117
Oxford, MS 38655
Phone (662) 550-4299

2406 Catalpa Ave
Pascagoula, MS 39567
Phone (228) 202-1006

1265 Union Ave
Memphis, TN 38104
Phone (901) 516-2362

Organizations & group practices 9

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 60

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1352937600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1697500800000",
    "number": "1770827867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1900 EXETER RD",
            "address_2": "SUITE 210",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382954",
            "telephone_number": "662-315-0843",
            "fax_number": "901-682-9522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1900 EXETER RD",
            "address_2": "SUITE 210",
            "city": "GERMANTOWN",
            "state": "TN",
            "postal_code": "381382954",
            "telephone_number": "662-315-0843",
            "fax_number": "901-682-9522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIS",
        "first_name": "DANA",
        "middle_name": "NICHOLE",
        "name_prefix": "Mrs.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-11-15",
        "last_updated": "2023-10-17",
        "certification_date": "2023-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "175063",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "90893",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "175063",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "12518435",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE/HUMANA/CHAMPUS",
            "identifier": "1770827867",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "196343001",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF TN",
            "identifier": "4342060",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DANA",
            "last_name": "RYAN",
            "middle_name": "NICHOLE",
            "prefix": "MISS",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Germantown, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2023; 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.