NPIMap

Organization Active NPI

White River Anesthesia Associates, Inc

  • Anesthesiology Physician
  • Branson, MO
National Provider Identifier
1013973296
Registry record updated Jun 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
WHITE RIVER ANESTHESIA ASSOCIATES, INC
Practice address
525 Branson Landing Blvd
Branson, MO 65616-2052
Phone
(417) 239-3392
Fax
(417) 239-3394
NPI assigned
Apr 25, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2016

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

Authorized official

Name
Jacob K. Luder, M.D.
Title
President
Phone
(417) 239-3392

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207L00000X Primary
Certified Registered Nurse AnesthetistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 367500000X

Addresses

Primary practice location

525 Branson Landing Blvd
Branson, MO 65616-2052

Mailing address

PO Box 842120
Kansas City, MO 64184-2120
Phone (800) 277-8151

Other identifiers 5

IdentifierTypeStateIssuer
508765401MedicaidMO
200077410AMedicaidOK
DC8634OtherMORAILROAD
194111OtherMOMISSOURI BCBS
158909002MedicaidAR

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464739200000",
    "number": "1013973296",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 842120",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641842120",
            "telephone_number": "800-277-8151"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 BRANSON LANDING BLVD",
            "city": "BRANSON",
            "state": "MO",
            "postal_code": "656162052",
            "telephone_number": "417-239-3392",
            "fax_number": "417-239-3394"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WHITE RIVER ANESTHESIA ASSOCIATES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2016-06-01",
        "status": "A",
        "authorized_official_last_name": "LUDER",
        "authorized_official_first_name": "JACOB",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "417-239-3392",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "508765401",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200077410A",
            "state": "OK"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "DC8634",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MISSOURI BCBS",
            "identifier": "194111",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158909002",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Branson, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.