Individual provider Active NPI

Jill L. Lord, CRNA

  • Certified Registered Nurse Anesthetist
  • Charlotte, NC
National Provider Identifier
1982648747
Registry record updated Jun 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
101462 Issued in NC
Practice address
1000 Blythe Blvd
Charlotte, NC 28203-5812
Phone
(704) 355-8983
NPI assigned
Jun 15, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2010

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 101462 NC Primary

Addresses

Primary practice location

1000 Blythe Blvd
Charlotte, NC 28203-5812

Mailing address

PO Box 32861
Anesthesia SVCS - 5TH Floor Surgery Tower
Charlotte, NC 28232-2861
Phone (704) 355-8983

Other identifiers 2

IdentifierTypeStateIssuer
NAN669MedicaidSC
8050773MedicaidNC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20071005000319 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 6709971781 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
101462NCMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
East Carolina Anesthesia Associates, PLLC Nurse Anesthetist, Certified Registered CurrentSince Mar 15, 2019 Accepting new patients
CHS Anesthesia Services Group Inc CurrentSince Dec 20, 2017 Accepting new patients
CMC-Northeast, Inc. Nurse Anesthetist, Certified Registered Past Accepting new patients
The Charlotte-Mecklenburg Hospital Authority Past Accepting new patients

Locations

2825 Randolph Rd
Charlotte, NC 28211
Phone (704) 377-1647

1000 Blythe Blvd
Charlotte, NC 28203
Phone (704) 351-3791

920 Church St N
Concord, NC 28025
Phone (704) 403-3000

2430 Emerald Pl
Ste 103
Greenville, NC 27834
Phone (252) 752-2140

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.

NPI Registry JSON

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

{
    "created_epoch": "1150329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1277856000000",
    "number": "1982648747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 32861",
            "address_2": "ANESTHESIA SVCS - 5TH FLOOR SURGERY TOWER",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282322861",
            "telephone_number": "704-355-8983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 BLYTHE BLVD",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282035812",
            "telephone_number": "704-355-8983"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LORD",
        "first_name": "JILL",
        "middle_name": "L.",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-15",
        "last_updated": "2010-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "101462",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NAN669",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8050773",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2010; 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.