NPIMap

Individual provider Active NPI

Kevin G Brister

  • Certified Registered Nurse Anesthetist
  • Alexandria, LA
National Provider Identifier
1013167550
Registry record updated Oct 12, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
AP05710 Issued in LA
Practice address
1444 Peterman Dr
Alexandria, LA 71301-3432
Phone
(318) 442-5399
Fax
(318) 442-1586
NPI assigned
Sep 20, 2008
Last updated
Oct 12, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 12, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X AP05710 LA Primary
Registered Nurse 163W00000X RN080838 LA

Addresses

Primary practice location

1444 Peterman Dr
Alexandria, LA 71301-3432

Mailing address

15038 Highway 8
Colfax, LA 71417-5080
Phone (318) 793-8896

Other identifiers 1

IdentifierTypeStateIssuer
1881180MedicaidLA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090616000817 LA Practitioner - Certified Registered Nurse Anesthetist (Crna) 3870643620 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mid-Louisiana Anesthesia Consultants, ApmcGroup PAC ID 3971408733, 53 clinicians

Practice addresses (Care Compare)

1444 Peterman Dr
Alexandria, LA 71301-3432
Phone (318) 442-5399

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
RN080838LAMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Mid-Louisiana Anesthesia Consultants, Apmc CurrentSince May 1, 2009 Accepting new patients
Professional Anesthesia Consultants, LLP Past Accepting new patients

Locations

1444 Peterman Dr
Alexandria, LA 71301
Phone (318) 442-5399

211 4th St
Alexandria, LA 71301
Phone (318) 473-3000

211 4th St
#30135
Alexandria, LA 71301
Phone (318) 448-4440

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 18

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1221868800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318377600000",
    "number": "1013167550",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15038 HIGHWAY 8",
            "city": "COLFAX",
            "state": "LA",
            "postal_code": "714175080",
            "telephone_number": "318-793-8896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1444 PETERMAN DR",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713013432",
            "telephone_number": "318-442-5399",
            "fax_number": "318-442-1586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRISTER",
        "first_name": "KEVIN",
        "middle_name": "G",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-09-20",
        "last_updated": "2011-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "LA",
            "license": "AP05710",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "LA",
            "license": "RN080838",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1881180",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.