MR. ELLIS R JACKSON (NPI# 1659362283) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659362283 |
| Entity Type | Individual |
| Full Name | MR. ELLIS R JACKSON |
| Credential | CRNA |
| Practice Address |
610 3rd St Macon GA 31201-3294 |
| Mailing Address |
427 Fussell Rd Leesburg GA 31763-5210 |
| Practice Telephone | 2293446080 |
| Practice Fax Number | 2294368649 |
| Mailing Telephone | 2293446080 |
| Mailing Fax Number | 2294368649 |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2017-04-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | RN066377 | GA | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | RR MEDICARE | P00220709 | 01 |
| GA | 334081730A | 05 |
| Street Address |
610 3RD ST |
| City | MACON |
| State | GA |
| Zip Code | 31201-3294 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922463132 | Macon Gastroenterology Anesthesia Associates LLC | Anesthesiology | 610 3rd St, Suite 204, Macon, GA 31201-3294 | 2015-12-15 |
| 1275909426 | Kayla Melissa Holloway | Nurse Practitioner | 610 3rd St, Macon, GA 31201-3294 | 2015-08-11 |
| 1942602941 | Your Doctor's After Hours, LLC | Clinic/Center | 610 3rd St, Macon, GA 31201-3294 | 2014-09-22 |
| 1790190817 | Adrienne Kathleen Earl | Nurse Practitioner | 610 3rd St, Suite 202, Macon, GA 31201-3294 | 2014-06-26 |
| 1871861823 | Midstate Anesthesia, LLC | Nurse Anesthetist, Certified Registered | 610 3rd St, Ste 206, Macon, GA 31201-3262 | 2011-12-06 |
| 1194000489 | Lauren Mathews Dykes | Nurse Practitioner | 610 3rd St, Suite 204, Macon, GA 31201-3294 | 2011-10-18 |
| 1578886941 | Jessica G Kosmowski | Nurse Anesthetist, Certified Registered | 610 3rd St, Suite 206, Macon, GA 31201-3294 | 2010-03-12 |
| 1154650091 | Synthesis Pathology, LLC | Clinical Medical Laboratory | 610 3rd St, Suite 206, Macon, GA 31201-3294 | 2009-12-23 |
| 1437381480 | Sarah Pittard Hobbs | Nurse Practitioner | 610 3rd St, Suite 204, Macon, GA 31201-3294 | 2009-08-10 |
| 1811174964 | Eclipse Anesthesia LLC | Nurse Anesthetist, Certified Registered | 610 3rd St, Ste 206, Macon, GA 31201-3294 | 2008-01-30 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639666340 | Yasameen Emad Muzahim | Internal Medicine | 777 Hemlock Street, Msc 165, Macon, GA 31201 | 2018-04-18 |
| 1952819419 | Putnam Dialysis LLC | Clinic/Center | 657 Hemlock Street, Suite 200, Macon, GA 31201 | 2018-01-18 |
| 1730604331 | Graham Arthur Mercier | Surgery | 169 Ashley Ave., Room 202 Main Hospital Msc 333, Charleston, SC 31201 | 2017-08-04 |
| 1376075705 | Diamond Jude | Internal Medicine | 777 Hemlock Street Msc #104, Macon, GA 31201 | 2017-04-03 |
| 1174055263 | Carol Roobin Bashuk | Hearing Instrument Specialist | 634 First Street, Macon, GA 31201 | 2017-03-29 |
| 1144752411 | Hubert Pare | Student in an Organized Health Care Education/Training Program | 777 Hemlock Street, Msc# 165, Macon, GA 31201 | 2017-03-28 |
| 1548613789 | Michael Daugherty | Counselor | 1873 Hardeman Ave, Suite 1, Macon, GA 31201 | 2016-07-22 |
| 1316317993 | 4front Healthcare of Middle Georgia, LLC | Hospice Care, Community Based | 682 1st St, Macon, GA 31201 | 2015-09-25 |
| 1881073054 | Andrew Lee Drahos | Surgery | 777 Hemlock St # 140, Macon, GA 31201 | 2015-05-21 |
| 1720474158 | April Nicole Colley | Nurse Practitioner | 1014 Forsyth Street, Macon, GA 31201 | 2015-04-13 |
| Find all providers in zip 31201 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962925974 | Tracy Joy Hurdle Joiner | Nurse Anesthetist, Certified Registered | 350 Hospital Dr Ste 410, Macon, GA 31217-3838 | 2017-07-21 |
| 1164881090 | Heather Brooks | Nurse Anesthetist, Certified Registered | 305 Whittington Dr, Macon, GA 31216-6585 | 2016-02-20 |
| 1306123336 | Nmda Anesthesia LLC | Nurse Anesthetist, Certified Registered | 577 Mulberry St Ste 110, Macon, GA 31201-8220 | 2011-11-04 |
| 1639303126 | Astoria Anesthesia Associates LLC | Nurse Anesthetist, Certified Registered | 403 Lakeview Pl, Macon, GA 31211-6127 | 2009-05-12 |
| 1780842633 | Jeffrey Elliott Cryder | Nurse Anesthetist, Certified Registered | 179 Mason Philip Drive, Macon, GA 31216-7366 | 2008-05-28 |
| 1720260045 | Ray Stapleton, Crna P.C. | Nurse Anesthetist, Certified Registered | 5309 Whitehouse Plantation Rd., Macon, GA 31210 | 2007-11-28 |
| 1275748774 | Wendy J. Gigliotti | Nurse Anesthetist, Certified Registered | 360 Fairways Dr, Macon, GA 31220-8776 | 2007-05-10 |
| 1780805564 | Jason Sirny | Nurse Anesthetist, Certified Registered | 610 Plum, Macon, GA 31201 | 2007-05-01 |
| 1194896324 | Mary Kay Lampe | Nurse Anesthetist, Certified Registered | 405 Noll Dr, Macon, MO 63552-3649 | 2006-11-10 |
| 1356396600 | Markus Eduardo Roberson | Nurse Anesthetist, Certified Registered | 6816 Bay Point Dr, Macon, GA 31220-5260 | 2006-05-24 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.