Paul Roger Backus, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Lenoir City, TN
NPI 1790721876 · NPPES record last updated Jan 11, 2011
Key facts
- NPI
- 1790721876
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 51127 (TN)
- Practice address
- 550 Fort Loudoun Medical Center Drive
Lenoir City, TN 37772-5673 - Phone
- (865) 777-0909
- Fax
- (865) 777-0910
- NPI assigned
- Jun 20, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5986A | KY | MD | Certified Registered Nurse Anesthetist |
| 9088 | TN | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Resource Anesthesia Lakeway, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 51127 | TN | Yes |
| Certified Registered Nurse Anesthetist | 367500000X | 5986A | KY | |
| Certified Registered Nurse Anesthetist | 367500000X | 9088 | TN |
Addresses
Primary practice location
550 Fort Loudoun Medical Center Drive
Lenoir City, TN 37772-5673
Mailing address
12752 Kingston Pike
Ste E202
Knoxville, TN 37934-0948
Phone (865) 777-0909
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3037713 | Other | TN | BLUECARE |
| 3600330 | Medicaid | TN | |
| 100021676 | Other | TN | PHP TENNCARE |
| 430009899 | Other | TN | MEDICARE TRAVELERS |
| 1502526 | Medicaid | TN | |
| 3037713 | Other | TN | BLUE CROSS |
| 4173676 | Other | TN | BLUE CROSS/BLUE SHIELD |
| 000000616087 | Other | KY | BLUE CROSS/BLUE SHIELD |
| P00810612 | Other | KY | RAILROAD MEDICARE PIN |
| P00479791 | Other | TN | RAILROAD MEDICARE PIN |
Other providers in Lenoir City, TN
- Farrukh Ashraf
- Association of University Radiologists, PC
- Autism & Behavioral Center, Inc.
- Back Center, PLLC
- Back to Nu Low T Solutions, LLC
- Baptist Family Health Care Center
- Johnny Keith Barnes Jr.
- Olivia Barnett
- Carolina Isabel Beardsley
- Alicia Beauchamp
All providers in Lenoir City, TN · Certified Registered Nurse Anesthetist in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.