Individual provider Active NPI

Gleyndon Mikeal Louis Kern

  • Certified Registered Nurse Anesthetist
  • Mobile, AL
National Provider Identifier
1063299642
Registry record updated Sep 8, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1-140476 Issued in AL
Practice address
3719 Dauphin St
Mobile, AL 36608-1753
Phone
(251) 344-9630
NPI assigned
Sep 8, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 1-140476 AL Primary

Addresses

Primary practice location

3719 Dauphin St
Mobile, AL 36608-1753

Mailing address

10495 Kearns Rd
Theodore, AL 36582-7455
Phone (251) 610-5521

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231006002176 AL Practitioner - Certified Registered Nurse Anesthetist (Crna) 8820443187 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blue Lake Health Springhill LLCGroup PAC ID 2365830007, 47 clinicians

Practice addresses (Care Compare)

3719 Dauphin St
Mobile, AL 36608-1753
Phone (251) 460-5220

Hospital & facility affiliations

  • Springhill Medical Center Hospital, Mobile, AL, CCN 010144

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1-140476ALMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Blue Lake Health Springhill, LLC CurrentSince Sep 11, 2023 Accepting new patients

Locations

3719 Dauphin St
Mobile, AL 36608
Phone (251) 342-3000

Organizations & group practices 1

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

Hospital & facility affiliations 1

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": "1694131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694131200000",
    "number": "1063299642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10495 KEARNS RD",
            "city": "THEODORE",
            "state": "AL",
            "postal_code": "365827455",
            "telephone_number": "251-610-5521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3719 DAUPHIN ST",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366081753",
            "telephone_number": "251-344-9630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KERN",
        "first_name": "GLEYNDON",
        "middle_name": "MIKEAL LOUIS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-08",
        "last_updated": "2023-09-08",
        "certification_date": "2023-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AL",
            "license": "1-140476",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mobile, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2023; 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.