Individual provider Active NPI

Brian Fenn, CRNA

  • Certified Registered Nurse Anesthetist
  • Plymouth, MA
National Provider Identifier
1891779732
Registry record updated Jan 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN174475 Issued in MA
Practice address
275 Sandwich St
Plymouth, MA 02360
Phone
(508) 746-2000
NPI assigned
Dec 5, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 4, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN174475 MA Primary
Certified Registered Nurse Anesthetist 367500000X 062441-23 NH

Addresses

Primary practice location

275 Sandwich St
Plymouth, MA 02360

Mailing address

275 Sandwich St
Plymouth, MA 02360-2183
Phone (508) 746-2000

Other practice location 1

One Medical Village Drive
Independent Anesthesiologists PSC
Edgewood, KY 41017
Phone (859) 341-7246

Other practice location 2

One Medical Village Drive
Independent Anesthesiologists PSC
Edgewood, KY 41017
Phone (859) 341-7246

Other practice location 3

789 Central Ave
Dover, NH 03820-2526
Phone (603) 609-6819

Other identifiers 5

IdentifierTypeStateIssuer
0810500MedicaidOH
3134668MedicaidNH
74382060MedicaidKY
000000179713OtherANTHEM BLUE SHIELD
200419580MedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA, NH2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20160523001286 MA Practitioner - Certified Registered Nurse Anesthetist (Crna) 0345218376 Reassigns benefits to 3 organizations
I20220922003151 NH Practitioner - Certified Registered Nurse Anesthetist (Crna) 0345218376 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Winchester Anesthesia Associates, IncGroup PAC ID 7315977196, 64 clinicians

Practice addresses (Care Compare)

41 Highland Ave
Winchester, MA 01890-1446
Phone (781) 756-2190

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4258CTMDGeneral Practice Dentistry
062441-23NHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is Current Accepting new patients
Barrington Surgical Care LLC CurrentSince Sep 19, 2022 Accepting new patients
Winchester Anesthesia Associates, Inc CurrentSince Jan 1, 2023 Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is CurrentSince Sep 9, 2018 Accepting new patients
Icon Anesthesia Services of New England LLC CurrentSince Aug 1, 2023 Accepting new patients
Associated Physicians of Harvard Medical Faculty Physicians at Beth Is CurrentSince Sep 9, 2018 Accepting new patients
Rye Surgical Center, LLC CurrentSince Sep 19, 2022 Accepting new patients
Northeast Medical Consultants PC CurrentSince Sep 19, 2022 Accepting new patients
Winchester Anesthesia Associates 2 Inc CurrentSince Jan 1, 2023 Accepting new patients
Waterbury Anesthesiology Assoc. Inc Past Accepting new patients
Western Ohio Anesthesia Associates Past Accepting new patients

Locations

25 Highland Ave
Newburyport, MA 01950
Phone (978) 258-4734

275 Sandwich St
Plymouth, MA 02360
Phone (508) 746-2000

41 Highland Ave
Winchester, MA 01890
Phone (781) 756-2000

944 Calef Hwy
Barrington, NH 03825
Phone 6036640100118

2 Pillsbury St
Ste 100
Concord, NH 03301
Phone (603) 224-2020

31 Main St
Plaistow, NH 03865
Phone (603) 382-4741

270 Lafayette Rd
Rye, NH 03870
Phone (603) 319-1581

Organizations & group practices 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1133740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1672790400000",
    "number": "1891779732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "275 SANDWICH ST",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "023602183",
            "telephone_number": "508-746-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "275 SANDWICH ST",
            "city": "PLYMOUTH",
            "state": "MA",
            "postal_code": "02360",
            "telephone_number": "508-746-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "One Medical Village Drive",
            "address_2": "Independent Anesthesiologists PSC",
            "address_purpose": "LOCATION",
            "city": "Edgewood",
            "state": "KY",
            "postal_code": "41017",
            "country_code": "US",
            "telephone_number": "859-341-7246",
            "fax_number": "859-341-7867",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "One Medical Village Drive",
            "address_2": "Independent Anesthesiologists PSC",
            "address_purpose": "LOCATION",
            "city": "Edgewood",
            "state": "KY",
            "postal_code": "41017",
            "country_code": "US",
            "telephone_number": "859-341-7246",
            "fax_number": "859-341-7867",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "789 Central Ave",
            "address_purpose": "LOCATION",
            "city": "Dover",
            "state": "NH",
            "postal_code": "038202526",
            "country_code": "US",
            "telephone_number": "603-609-6819",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FENN",
        "first_name": "BRIAN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-05",
        "last_updated": "2023-01-04",
        "certification_date": "2023-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MA",
            "license": "RN174475",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NH",
            "license": "062441-23",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0810500",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3134668",
            "state": "NH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "74382060",
            "state": "KY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE SHIELD",
            "identifier": "000000179713",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200419580",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; 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.