Individual provider Active NPI

Michael Paul Clancy, CRNA

  • Certified Registered Nurse Anesthetist
  • Georgetown, KY
National Provider Identifier
1881408169
Registry record updated Feb 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
4035089 Issued in KY
Practice address
1140 Lexington Rd
Georgetown, KY 40324-9330
Phone
(502) 868-1100
NPI assigned
Feb 5, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 5, 2025

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 4035089 KY Primary

Addresses

Primary practice location

1140 Lexington Rd
Georgetown, KY 40324-9330

Mailing address

3701 Mariner Dr
Evansville, IN 47711-7029
Phone (706) 993-0780

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250221003388 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 6507386406 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Kentucky Anesthesia Group PSCGroup PAC ID 4082527890, 38 clinicians

Practice addresses (Care Compare)

1140 Lexington Rd
Georgetown, KY 40324-9330
Phone (502) 868-1100

9 Linville Rd
Paris, KY 40361-2129
Phone (859) 987-3600

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Kentucky Anesthesia Group, PSC Nurse Anesthetist, Certified Registered CurrentSince Feb 12, 2025 Accepting new patients

Locations

1 Trillium Way
Corbin, KY 40701
Phone (606) 523-8521

275 Highway 770
Corbin, KY 40701
Phone (606) 526-7874

1140 Lexington Rd
Georgetown, KY 40324
Phone (502) 868-1100

320 N Loretto Rd
Lebanon, KY 40033
Phone (270) 692-3161

9 Linville Dr
Paris, KY 40361
Phone (859) 987-3600

360 Amsden Ave
Versailles, KY 40383
Phone (606) 873-3111

Organizations & group practices 1

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 2

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": "1738713600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738713600000",
    "number": "1881408169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 MARINER DR",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477117029",
            "telephone_number": "706-993-0780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 LEXINGTON RD",
            "city": "GEORGETOWN",
            "state": "KY",
            "postal_code": "403249330",
            "telephone_number": "502-868-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLANCY",
        "first_name": "MICHAEL",
        "middle_name": "PAUL",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-02-05",
        "last_updated": "2025-02-05",
        "certification_date": "2025-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "4035089",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Georgetown, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2025; 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.