Individual provider Active NPI

Johnathan Nathaniel Haley, CRNA

  • Certified Registered Nurse Anesthetist
  • Greenwood, SC
National Provider Identifier
1780856047
Registry record updated Mar 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3511 Issued in SC
Practice address
1325 Spring St
Greenwood, SC 29646-3860
Phone
(864) 725-4111
NPI assigned
Mar 27, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2024

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 3511 SC Primary

Addresses

Primary practice location

1325 Spring St
Greenwood, SC 29646-3860

Mailing address

PO Box 819
Greenwood, SC 29648-0819
Phone (706) 860-2701

Other practice location 1

1325 Spring St
Anesthesia Department
Greenwood, SC 29646-3860
Phone (706) 860-2701

Other identifiers 1

IdentifierTypeStateIssuer
AN1690MedicaidSC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080429000579 SC Practitioner - Certified Registered Nurse Anesthetist (Crna) 2668550856 Reassigns benefits to 1 organization
I20160418000419 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 2668550856 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Medical College of Georgia School of Medicine, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Consultants of AthensGroup PAC ID 2567459902, 55 clinicians
Self Medical GroupGroup PAC ID 6002953916, 393 clinicians

Practice addresses (Care Compare)

1230 Baxter St
Athens, GA 30606-3712
Phone (706) 543-3449

1325 Spring St
Greenwood, SC 29646-3860
Phone (864) 725-4111

Hospital & facility affiliations

  • St Mary'S Hospital Hospital, Athens, GA, CCN 110006
  • Self Regional Healthcare Hospital, Greenwood, SC, CCN 420071

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Self Medical Group CurrentSince Apr 1, 2024 Accepting new patients
Self Medical Group Current Accepting new patients
Sentry Anesthesia Management, LLC CurrentSince Feb 1, 2025 Accepting new patients
Self Medical Group CurrentSince Apr 1, 2024 Accepting new patients
Anesthesia Consultants of Athens CurrentSince Apr 1, 2016 Accepting new patients
Synergy Spine Center, PA Past Accepting new patients
Surgery Center Anesthesia Providers PC Nurse Anesthetist, Certified Registered Past Accepting new patients
Self Medical Group PastSince May 7, 2024 Accepting new patients
Nationwide Anesthesia Partners, Inc. Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

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

651 S Milledge Ave
Athens, GA 30605
Phone (706) 546-9290

1500 Oglethorpe Ave
Ste 2100
Athens, GA 30606
Phone (706) 425-5437

1230 Baxter St
Athens, GA 30606
Phone (706) 364-3100

75 Remittance Dr
Dept 6764
Chicago, IL 60675

1325 Spring St
Greenwood, SC 29646
Phone (864) 227-4111

101 Academy Ave
Greenwood, SC 29646
Phone (864) 227-8242

2605 Kinard St
Ste 200
Newberry, SC 29108
Phone (803) 276-1866

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 and National Provider Directory roles.

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": "1206576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710460800000",
    "number": "1780856047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 819",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296480819",
            "telephone_number": "706-860-2701",
            "fax_number": "706-737-2271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1325 SPRING ST",
            "city": "GREENWOOD",
            "state": "SC",
            "postal_code": "296463860",
            "telephone_number": "864-725-4111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1325 Spring St",
            "address_2": "Anesthesia Department",
            "address_purpose": "LOCATION",
            "city": "Greenwood",
            "state": "SC",
            "postal_code": "296463860",
            "country_code": "US",
            "telephone_number": "706-860-2701",
            "fax_number": "706-737-2271",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HALEY",
        "first_name": "JOHNATHAN",
        "middle_name": "NATHANIEL",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-27",
        "last_updated": "2024-03-15",
        "certification_date": "2024-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SC",
            "license": "3511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AN1690",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenwood, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 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.