SURGERY CENTER ANESTHESIA PROVIDERS PC – Certified Registered Nurse Anesthetist, NPI 1073807376
Certified Registered Nurse Anesthetist
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for SURGERY CENTER ANESTHESIA PROVIDERS PC
1000 CENTRE BROOK CT
COLUMBUS, GA 319044573
Phone: (336) 472-7289
Type: Location
7269 TROTTERS RUN
TRINITY, NC 273707394
Phone: (800) 204-0099
Fax: (336) 882-2216
Type: Mailing
1000 Centre Brook Ct
Columbus, GA 319044573
Phone: (336) 472-7289
Type: Location
2010 Bremo Rd Ste 132
Richmond, VA 232262444
Phone: (804) 285-0680
Fax: (952) 442-3620
Type: Location
5215 MONTICELLO AVE
WILLIAMSBURG, VA 231888232
Phone: (757) 229-4000
Fax: (952) 442-3620
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2025-10-28
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-05-31 (740 days ago).
Enrollment records
4
Earliest due date
2024-05-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20110706000331 | O | Clinic/Group Practice | GA | TBD |
| O20120406000016 | O | Clinic/Group Practice | NC | TBD |
| O20190516002751 | O | Clinic/Group Practice | VA | 2024-05-31 |
| O20251028001505 | O | Clinic/Group Practice | TX | TBD |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 31904)
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