Individual provider Active NPI

Kristin R Mahaffey, CRNA

  • Certified Registered Nurse Anesthetist
  • Huntsville, AL
National Provider Identifier
1790058600
Registry record updated Jan 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1-115930 Issued in AL
Practice address
1 Hospital Dr SW
Huntsville, AL 35801-6455
Phone
(256) 429-5071
Fax
(256) 429-4674
NPI assigned
Feb 23, 2012
Last updated
Jan 15, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 15, 2013

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 1-115930 AL Primary

Addresses

Primary practice location

1 Hospital Dr SW
Huntsville, AL 35801-6455

Mailing address

PO Box 5538
Fresno, CA 93755-5538
Phone (559) 436-1000

Other identifiers 1

IdentifierTypeStateIssuer
PENDINGMedicaidAL

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120313000347 AL Practitioner - Certified Registered Nurse Anesthetist (Crna) 2062671944 Reassigns benefits to 3 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1-115930ALMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Physynergy, LLC Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2013 Accepting new patients
Physynergy, LLC Nurse Anesthetist, Certified Registered Current Accepting new patients
Comprehensive Anesthesia Services PC CurrentSince Jan 1, 2022 Accepting new patients
Anesthesia Services of Decatur PC CurrentSince Jun 24, 2017 Accepting new patients
Alabama Anesthesia of Huntsville LLC Nurse Anesthetist, Certified Registered Past Accepting new patients
The Sylacauga Health Care Authority Past Accepting new patients
Physynergy, LLC Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

1201 7th St SE
Decatur, AL 35601
Phone (256) 341-2000

1874 Beltline Rd SW
Decatur, AL 35601
Phone (256) 301-2211

1 Hospital Dr SW
Huntsville, AL 35801
Phone (256) 429-4000

2006 Franklin St SE
Ste 301
Huntsville, AL 35801
Phone (256) 539-9471

245 Governors Dr SE
Huntsville, AL 35801
Phone (256) 265-7673

709 Ward Ave NE
Huntsville, AL 35801
Phone (256) 539-9471

460 Lanier Rd
Ste 100
Madison, AL 35758
Phone (256) 319-9000

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1329955200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358208000000",
    "number": "1790058600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5538",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937555538",
            "telephone_number": "559-436-1000",
            "fax_number": "559-354-4235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 HOSPITAL DR SW",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "358016455",
            "telephone_number": "256-429-5071",
            "fax_number": "256-429-4674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAHAFFEY",
        "first_name": "KRISTIN",
        "middle_name": "R",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-23",
        "last_updated": "2013-01-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AL",
            "license": "1-115930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntsville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.