NPIMap

Individual provider Active NPI

Juanjeca Quiyatta Barrow

  • Certified Registered Nurse Anesthetist
  • Jackson, TN
National Provider Identifier
1922746239
Registry record updated Feb 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
28371 Issued in SC
Practice address
52 Pemberton CV
Jackson, TN 38305-5514
Phone
(731) 234-5663
NPI assigned
May 25, 2022
Last updated
Feb 27, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2024

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 RN230487 GA
Certified Registered Nurse Anesthetist 367500000X 28371 SC Primary

Addresses

Primary practice location

52 Pemberton CV
Jackson, TN 38305-5514

Mailing address

52 Pemberton CV
Jackson, TN 38305-5514

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240311000711 SC Practitioner - Certified Registered Nurse Anesthetist (Crna) 2567808736 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Beach Anesthesia, LLCGroup PAC ID 6103924014, 91 clinicians
Musc Community PhysiciansGroup PAC ID 6507260668, shared by 9 NPIs, 1,353 clinicians
Tidelands Anesthesia Group LLCGroup PAC ID 5395258065, 51 clinicians
Medstream Anesthesia PLLCGroup PAC ID 7416198049, 571 clinicians

Practice addresses (Care Compare)

109 Blarney Dr
Columbia, SC 29223-6244
Phone (803) 865-8200

4040 Hwy 17
Unit 103
Murrells Inlet, SC 29576-5098
Phone (843) 652-8230

4070 Hwy 17
Murrells Inlet, SC 29576-5033
Phone (843) 652-1000

506 N St
Bamberg, SC 29003-1319
Phone (803) 245-6290

606 Black River Rd
Georgetown, SC 29440-3304
Phone (843) 527-7100

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN230487GAMDRegistered Nurse
28371SCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Tidelands Anesthesia Group LLC CurrentSince Jul 20, 2025 Accepting new patients
Beach Anesthesia, LLC CurrentSince Apr 1, 2025 Accepting new patients
Medstream Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Feb 26, 2024 Accepting new patients

Locations

109 Blarney Dr
Columbia, SC 29223
Phone (803) 865-8200

606 Black River Rd
Georgetown, SC 29440
Phone (843) 527-7000

2669 Kinard St
Newberry, SC 29108
Phone (803) 276-7570

Organizations & group practices 3

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 16

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1653436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708992000000",
    "number": "1922746239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "52 PEMBERTON CV",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383055514"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "52 PEMBERTON CV",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383055514",
            "telephone_number": "731-234-5663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARROW",
        "first_name": "JUANJECA",
        "middle_name": "QUIYATTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-05-25",
        "last_updated": "2024-02-27",
        "certification_date": "2024-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "GA",
            "license": "RN230487",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SC",
            "license": "28371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2024; 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.