Individual provider Active NPI

Joseph A Forrest, CRNA

  • Certified Registered Nurse Anesthetist
  • Bristol, TN
National Provider Identifier
1962404715
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN0000056894 Issued in TN
Practice address
1 Medical Park Blvd
Bristol, TN 37620-7430
Phone
(423) 968-4540
Fax
(423) 968-5697
NPI assigned
Aug 11, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 RN0000056894 TN Primary

Addresses

Primary practice location

1 Medical Park Blvd
Bristol, TN 37620-7430

Mailing address

730 Shadden Rd
Gray, TN 37615
Phone (423) 753-2653

Other identifiers 1

IdentifierTypeStateIssuer
3620119MedicaidTN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070313000280 TN Practitioner - Certified Registered Nurse Anesthetist (Crna) 9537262555 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9187TNMDSpeech-Language Pathologist
RN0000056894TNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Paragon Anesthesia PC Nurse Anesthetist, Certified Registered CurrentSince Jan 8, 2025 Accepting new patients
East Tennessee Ambulatory Surgery Center LLC CurrentSince Jan 8, 2025 Accepting new patients
Singing River Health System Past Accepting new patients
Anesthesia and Pain Consultants,P.C. Nurse Anesthetist, Certified Registered PastSince Mar 1, 2000 Accepting new patients

Locations

350 Blountville Hwy
Ste 108
Bristol, TN 37620
Phone (423) 844-6120

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

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962404715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "730 SHADDEN RD",
            "city": "GRAY",
            "state": "TN",
            "postal_code": "37615",
            "telephone_number": "423-753-2653"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL PARK BLVD",
            "city": "BRISTOL",
            "state": "TN",
            "postal_code": "376207430",
            "telephone_number": "423-968-4540",
            "fax_number": "423-968-5697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FORREST",
        "first_name": "JOSEPH",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "RN0000056894",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3620119",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bristol, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.