Keandrea Bacon, is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Ellenwood, Georgia. She graduated from nursing school in 2025 and has 1 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). She is a member of the group practice Grady Memorial Hospital Corporation and her current practice location is
120 Whirlaway Dr, Ellenwood, Georgia. You can reach out to her office (for appointments etc.) via phone at
(404) 444-3887.
Keandrea Bacon is licensed to practice in Georgia (license number CRNA233963) 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 1619712676.
Provider's Profile
| Full Name | Keandrea Bacon |
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| Gender | Female |
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| Speciality | Certified Registered Nurse Anesthetist (crna) |
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| Experience | 1 Years |
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| Location | 120 Whirlaway Dr, Ellenwood, Georgia |
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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. |
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Medical Education and Training:
- Keandrea Bacon graduated from nursing school in 2025
NPI Data:
- NPI Number: 1619712676
- Provider Enumeration Date: 07/01/2024
- Last Update Date: 09/23/2025
Medicare PECOS Information:
- PECOS PAC ID: 2062984438
- Enrollment ID: I20260617000011
Medical Identifiers
Medical identifiers for Keandrea Bacon such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1619712676 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 367500000X | Nurse Anesthetist, Certified Registered | CRNA233963 (Georgia) | Primary |
| 163W00000X | Registered Nurse | RN233963 (Georgia) | Secondary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Grady Memorial Hospital Corporation | 7517032998 | 365 |
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. Keandrea Bacon allows following entities to bill medicare on her behalf.
| Entity Name | Grady Memorial Hospital Corporation |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1114243813
PECOS PAC ID: 7517032998
Enrollment ID: O20100723000311 |
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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. Keandrea Bacon 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 |
|---|
Keandrea Bacon,
120 Whirlaway Dr,
Ellenwood, GA 30294-3259
Ph: (404) 444-3887 | Keandrea Bacon,
120 Whirlaway Dr,
Ellenwood, GA 30294-3259
Ph: (404) 444-3887 |
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