Marissa Lynette Commodore, CRNA - Medicare Nurse Anesthetist, Certified Registered in Stone Mountain, GA

  1. Home
Marissa Lynette Commodore, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" physician in Stone Mountain, Georgia. Her current practice location is 5357 Windfern Ct, Stone Mountain, Georgia. You can reach out to her office (for appointments etc.) via phone at (770) 875-3080.

Marissa Lynette Commodore is licensed to practice in Georgia (license number RN264280) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1881264356.

Contact Information

Marissa Lynette Commodore, CRNA
5357 Windfern Ct,
Stone Mountain, GA 30088-3329
(770) 875-3080
Not Available

Map and Direction




Physician's Profile

Full NameMarissa Lynette Commodore
GenderFemale
SpecialityNurse Anesthetist, Certified Registered
Location5357 Windfern Ct, Stone Mountain, Georgia
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1881264356
  • Provider Enumeration Date: 06/28/2021
  • Last Update Date: 05/23/2024
  Medicare PECOS Information:
  • PECOS PAC ID: 1658731690
  • Enrollment ID: I20230721001469

Medical Identifiers

Medical identifiers for Marissa Lynette Commodore such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1881264356NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
207L00000XAnesthesiology RN264280 (Georgia)Secondary
367500000XNurse Anesthetist, Certified Registered RN264280 (Georgia)Primary

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. Marissa Lynette Commodore allows following entities to bill medicare on her behalf.
Entity NameThe Emory Clinic Inc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1396798229
PECOS PAC ID: 8820901408
Enrollment ID: O20031110000503
Entity NameRockdale Anesthesia Services, P.c.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1619028396
PECOS PAC ID: 4284536855
Enrollment ID: O20040123000436
Entity NameEmory Specialty Associates, Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1407864168
PECOS PAC ID: 3476559782
Enrollment ID: O20061010000447
Entity NameAdvanced Urology Institute Of Georgia
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1073896510
PECOS PAC ID: 1759552607
Enrollment ID: O20110926000393
Entity NameCoastal Ambulatory Anesthesia Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1750753786
PECOS PAC ID: 1052613023
Enrollment ID: O20160107001775
Entity NameGi Anesthesia Of Georgia Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1326569187
PECOS PAC ID: 0446516769
Enrollment ID: O20171102000283
Entity NamePiedmont Anesthesia Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1700474244
PECOS PAC ID: 2163837972
Enrollment ID: O20210208002823
Entity NamePrimary Anesthesia Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1427640317
PECOS PAC ID: 1456768662
Enrollment ID: O20210405001643

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. Marissa Lynette Commodore 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 AddressPractice Location Address
Marissa Lynette Commodore, CRNA
5357 Windfern Ct,
Stone Mountain, GA 30088-3329

Ph: (770) 875-3080		Marissa Lynette Commodore, CRNA
5357 Windfern Ct,
Stone Mountain, GA 30088-3329

Ph: (770) 875-3080

Reviews and Comments



Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.