Individual provider Active NPI

Kyle Rodgers, CRNA

  • Certified Registered Nurse Anesthetist
  • Albuquerque, NM
National Provider Identifier
1013332998
Registry record updated Jul 20, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
63685 Issued in NM
Practice address
6709 Academy Rd NE Ste a
Albuquerque, NM 87109-3363
Phone
(505) 308-3145
NPI assigned
Feb 28, 2014
Last updated
Jul 20, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 20, 2022

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 RN60423007 WA
Certified Registered Nurse Anesthetist 367500000X 63685 NM Primary

Addresses

Primary practice location

6709 Academy Rd NE Ste a
Albuquerque, NM 87109-3363

Mailing address

PO Box 50095
Seattle, WA 98145-5095
Phone (206) 543-6420

Other practice location 1

1959 NE Pacific St
Box 356540
Seattle, WA 98195-0001
Phone (206) 543-2470

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address krodgers808224@oc.providencedirect.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR, NM2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170912002181 OR Practitioner - Certified Registered Nurse Anesthetist (Crna) 6901021039 Reassigns benefits to 2 organizations
I20211210000251 NM Practitioner - Certified Registered Nurse Anesthetist (Crna) 6901021039 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Main Street Anesthesia of New Mexico, LLCGroup PAC ID 3476807538, 228 clinicians

Practice addresses (Care Compare)

504 Elm St NE
Heart Hospital of New Mexico
Albuquerque, NM 87102-2512
Phone (505) 727-1100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
63685NMMDCertified Registered Nurse Anesthetist
RN60423007WAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Oregon Anesthesiology Group PC CurrentSince Jan 1, 2020 Accepting new patients
Anesthesia Associates Northwest LLC CurrentSince Jun 11, 2019 Accepting new patients
Bosque Clinic LLC CurrentSince Feb 15, 2023 Accepting new patients
Main Street Anesthesia of New Mexico, LLC CurrentSince Sep 7, 2021 Accepting new patients
Columbia Lutheran Charities Past Accepting new patients
Columbia Lutheran Charities Past Accepting new patients

Locations

10501 Golf Course Rd NW
Albuquerque, NM 87114
Phone (505) 727-2000

504 Elm St NE
Albuquerque, NM 87102
Phone (505) 724-2000

6709 Academy Rd NE
Ste A
Albuquerque, NM 87109
Phone (505) 308-3145

117 E 19th St
Roswell, NM 88201
Phone (505) 727-2000

707 SW Washington St
Ste 700
Portland, OR 97205

1015 NW 22nd Ave
Portland, OR 97210
Phone (503) 413-7582

120 NW 14th Ave
Ste 200
Portland, OR 97209
Phone (503) 771-1883

6400 SE Lake Rd
Ste 130
Portland, OR 97222
Phone (503) 594-1774

Interoperability endpoints

  • Direct secure messaging: krodgers808224@oc.providencedirect.org

Organizations & group practices 6

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 2

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

NPI Registry JSON

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

{
    "created_epoch": "1393545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658275200000",
    "number": "1013332998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 50095",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981455095",
            "telephone_number": "206-543-6420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6709 ACADEMY RD NE STE A",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871093363",
            "telephone_number": "505-308-3145"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1959 NE Pacific St",
            "address_2": "Box 356540",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981950001",
            "country_code": "US",
            "telephone_number": "206-543-2470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RODGERS",
        "first_name": "KYLE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-02-28",
        "last_updated": "2022-07-20",
        "certification_date": "2022-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WA",
            "license": "RN60423007",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NM",
            "license": "63685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krodgers808224@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "725 S Wahanna Rd",
            "city": "Seaside",
            "state": "OR",
            "country_code": "US",
            "postal_code": "971387735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 2022; 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.