Miss Tiffany Shannon Ray, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Horn Lake, Mississippi. She graduated from nursing school in 2016 and has 8 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). She is a member of the group practice Poplar Avenue Clinic, Pllc, Gastroenterology Center Of The Midsouth Pllc, Poplar Avenue Clinic, Pllc and her current practice location is
6410 Walnut Grove Rd, Horn Lake, Mississippi. You can reach out to her office (for appointments etc.) via phone at
(901) 652-0880.
Miss Tiffany Shannon Ray is licensed to practice in Mississippi (license number R864509) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1114097615.
Provider's Profile
Full Name | Miss Tiffany Shannon Ray |
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Gender | Female |
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Speciality | Certified Registered Nurse Anesthetist (crna) |
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Experience | 8 Years |
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Location | 6410 Walnut Grove Rd, Horn Lake, Mississippi |
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Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Medical Education and Training:
- Miss Tiffany Shannon Ray graduated from nursing school in 2016
NPI Data:
- NPI Number: 1114097615
- Provider Enumeration Date: 11/09/2006
- Last Update Date: 07/08/2007
Medicare PECOS Information:
- PECOS PAC ID: 1153358072
- Enrollment ID: I20050722000275
Medical Identifiers
Medical identifiers for Miss Tiffany Shannon Ray such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1114097615 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
367500000X | Nurse Anesthetist, Certified Registered | R864509 (Mississippi) | Primary |
Group Practice Association
Group Practice Name | Group PECOS PAC ID | No. of Members |
Poplar Avenue Clinic, Pllc | 0042552457 | 12 |
Gastroenterology Center Of The Midsouth Pllc | 4880619824 | 138 |
Poplar Avenue Clinic, Pllc | 0042552457 | 12 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Miss Tiffany Shannon Ray allows following entities to bill medicare on her behalf.
Entity Name | Gastroenterology Center Of The Midsouth Pllc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1417932492 PECOS PAC ID: 4880619824 Enrollment ID: O20051010000483 |
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Entity Name | Willow Anesthesia Services, Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1205169521 PECOS PAC ID: 9234279183 Enrollment ID: O20091228000308 |
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Entity Name | Poplar Avenue Clinic, Pllc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1124588793 PECOS PAC ID: 0042552457 Enrollment ID: O20190506001682 |
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Entity Name | Soms Anesthesia, Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1063010189 PECOS PAC ID: 9133531254 Enrollment ID: O20201215000881 |
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Entity Name | Midsouth Speciality Anesthesia Services Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1245956440 PECOS PAC ID: 6103293667 Enrollment ID: O20221114002027 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Miss Tiffany Shannon Ray is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Miss Tiffany Shannon Ray, CRNA 6410 Walnut Grove Rd, Horn Lake, MS 38637-2023 Ph: (901) 652-0880 | Miss Tiffany Shannon Ray, CRNA 6410 Walnut Grove Rd, Horn Lake, MS 38637-2023 Ph: (901) 652-0880 |
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