Individual provider Active NPI

Seth D Johnson, CRNA

  • Certified Registered Nurse Anesthetist
  • Kingsport, TN
National Provider Identifier
1871007864
Registry record updated Apr 6, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
187831 Issued in TN
Practice address
130 W Ravine Rd
Kingsport, TN 37660-3837
Phone
(423) 224-4000
Fax
(423) 224-4746
NPI assigned
Nov 29, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 6, 2018

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 187831 TN
Certified Registered Nurse Anesthetist 367500000X 187831 TN Primary

Addresses

Primary practice location

130 W Ravine Rd
Kingsport, TN 37660-3837

Mailing address

105 W Stone Dr Ste 6a
Kingsport, TN 37660-3256
Phone (423) 408-7220

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180719001598 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 3173870300 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Paragon Anesthesia PCGroup PAC ID 8921044744, 214 clinicians

Practice addresses (Care Compare)

1 Medical Park Blvd
Bristol, TN 37620-7430
Phone (423) 390-0451

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
187831TNMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
American Anesthesiology of Tennessee, P.C. CurrentSince Aug 1, 2019 Accepting new patients
East Tennessee Ambulatory Surgery Center LLC CurrentSince Mar 1, 2023 Accepting new patients
Paragon Anesthesia PC Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2023 Accepting new patients
Singing River Health System Past Accepting new patients

Locations

1 Medical Park Blvd
Ste 210E
Bristol, TN 37620
Phone (423) 224-4000

1 Medical Park Blvd
Bristol, TN 37620
Phone (423) 390-0451

10415 Wallace Alley St
Kingsport, TN 37663
Phone (423) 390-0451

130 W Ravine Rd
Kingsport, TN 37660
Phone (423) 224-3150

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1511913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522972800000",
    "number": "1871007864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 W STONE DR STE 6A",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603256",
            "telephone_number": "423-408-7220",
            "fax_number": "423-408-7405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 W RAVINE RD",
            "city": "KINGSPORT",
            "state": "TN",
            "postal_code": "376603837",
            "telephone_number": "423-224-4000",
            "fax_number": "423-224-4746"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "SETH",
        "middle_name": "D",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-29",
        "last_updated": "2018-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "187831",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "187831",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Kingsport, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2018; 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.