Individual provider Active NPI

Ryan Justice McCormack, CRNA

  • Certified Registered Nurse Anesthetist
  • Chattanooga, TN
National Provider Identifier
1851984850
Registry record updated Dec 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
30840 Issued in TN
Practice address
2525 Desales Ave
Chattanooga, TN 37404-1161
Phone
(423) 495-2525
NPI assigned
Feb 19, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 0000214047 TN
Certified Registered Nurse Anesthetist 367500000X 30840 TN Primary

Addresses

Primary practice location

2525 Desales Ave
Chattanooga, TN 37404-1161

Mailing address

1808 Williams St
Chattanooga, TN 37408-1726
Phone (423) 605-3135

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220105001854 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 7416348289 Reassigns benefits to 2 organizations
I20251208002792 GA Practitioner - Certified Registered Nurse Anesthetist (Crna) 7416348289 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2333 McCallie Ave
Chattanooga, TN 37404-3258
Phone (865) 546-8040

2525 Desales Ave
Chattanooga, TN 37404-1161
Phone (423) 495-2525

4710 Battlefield Pkwy
Ringgold, GA 30736-5164
Phone (423) 495-2525

9300 Park W Blvd
Knoxville, TN 37923-4301
Phone (865) 546-8040

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
94.27 of 100Reported as apm
Quality
92.6
Promoting interoperability
93.23
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0000214047TNMDRegistered Nurse
30840TNMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Health Partners Foundation Inc CurrentSince Jul 1, 2024 Accepting new patients
Memorial Health Partners Foundation, Inc CurrentSince Jul 1, 2024 Accepting new patients
American Anesthesiology of Tennessee, P.C. Nurse Anesthetist, Certified Registered CurrentSince Dec 27, 2021 Accepting new patients
American Anesthesiology of Tennessee, P.C. CurrentSince Dec 27, 2021 Accepting new patients

Locations

611 E Villanow St
La Fayette, GA 30728
Phone (706) 638-1606

2525 Desales Ave
Chattanooga, TN 37404
Phone (423) 495-2620

5600 Brainerd Rd
Ste 500
Chattanooga, TN 37411
Phone (423) 414-3586

2051 Hamill Rd
Ste 301
Hixson, TN 37343
Phone (423) 870-3376

9300 Park West Blvd
Knoxville, TN 37923
Phone (865) 427-4040

Organizations & group practices 4

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 4

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": "1613692800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639612800000",
    "number": "1851984850",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1808 WILLIAMS ST",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374081726",
            "telephone_number": "423-605-3135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 DESALES AVE",
            "city": "CHATTANOOGA",
            "state": "TN",
            "postal_code": "374041161",
            "telephone_number": "423-495-2525"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCORMACK",
        "first_name": "RYAN",
        "middle_name": "JUSTICE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-02-19",
        "last_updated": "2021-12-16",
        "certification_date": "2021-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "0000214047",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "30840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chattanooga, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2021; 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.