SAMUEL V DAVENPORT CRNA
NPI 1083616056
Nurse Anesthetist, Certified Registered in Johnson City, TN
About Samuel V Davenport Crna NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SAMUEL V DAVENPORT CRNA (NPI 1083616056) is an individual nurse anesthetist, certified registered in Johnson City, Tennessee, licensed in Tennessee (RN0000104846) and active in the NPI registry since August 2005. He maintains a secondary practice location in Johnson City.
NPPES Registry Identity
Specialties & Licenses
Secondary Practice Location 1
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Samuel V Davenport Crna is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignment
Medicare enrollment records show Samuel Davenport reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.
Johnson City, TN 37604
- Reassigned Medicare billing, Tennessee enrollment
- Medicare enrollment name: Paragon Anesthesia PC
- 294 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Other Providers at the Same Location NPPES 20
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
JOHNSON CITY, TN 37604
JOHNSON CITY, TN 37604
JOHNSON CITY, TN 37604
JOHNSON CITY, TN 37604
JOHNSON CITY, TN 37604
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Samuel Davenport's NPI number?
The NPI number for Samuel Davenport is 1083616056. It was assigned to this individual provider in the NPPES registry on August 10, 2005.
Where is Samuel Davenport located?
Samuel Davenport practices at 400 N State Of Franklin Rd, Johnson City, TN 37604. The listed phone number is (423) 431-6111.
What is Samuel Davenport's specialty?
The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.
Is Samuel Davenport enrolled in Medicare?
Yes. Samuel Davenport is registered in the Medicare PECOS enrollment system.
Which organization bills Medicare for Samuel Davenport's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Samuel Davenport reassigns Medicare benefits to East Tennessee Ambulatory Surgery Center LLC (Johnson City, TN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Samuel Davenport's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Samuel Davenport accept?
Health plans from Cigna Healthcare list Samuel Davenport as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Samuel Davenport was last updated on April 24, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Samuel V Davenport, CRNA · NPI 1083616056
Nurse Anesthetist, Certified Registered physician in Johnson City, Tennessee. Individual provider, active in the CMS NPPES registry since August 10, 2005.
## Identity
- **NPI:** 1083616056 (Entity type: Individual)
- **Enumerated:** August 10, 2005
- **Primary specialty:** Nurse Anesthetist, Certified Registered · taxonomy 367500000X
- **State license:** RN0000104846 (Tennessee)
- **Sole proprietor:** No
## Practice location
- **Address:** 400 N STATE OF FRANKLIN RD, Johnson City, TN 37604-6035
- **Phone:** (423) 431-6111
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Bills Medicare through:** East Tennessee Ambulatory Surgery Center LLC (NPI 1659360071, Johnson City, TN), under Medicare reassignment (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 24, 2019
- **Other identifiers:** Medicaid 3631202 (TN)
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Source: [NPI Profile](https://npiprofile.com/npi/1083616056) · Data from the CMS NPPES public registry.