Individual provider Active NPI

Keith Robert Anderson, CRNA

  • Certified Registered Nurse Anesthetist
  • Grants Pass, OR
National Provider Identifier
1073590733
Registry record updated Mar 22, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
200460004CRNA Issued in OR
Practice address
500 SW Ramsey Ave
Grants Pass, OR 97527
Phone
(541) 472-7000
NPI assigned
Dec 23, 2005
Last updated
Mar 22, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 89000337RN OR
Certified Registered Nurse Anesthetist 367500000X 200460004CRNA OR Primary

Addresses

Primary practice location

500 SW Ramsey Ave
Grants Pass, OR 97527

Mailing address

2620 East Barnett Rd
Suite H
Medford, OR 97504
Phone (541) 789-5250

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080425000101 OR Practitioner - Certified Registered Nurse Anesthetist (Crna) 9537134655 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Rogue Anesthesia LLCGroup PAC ID 9830162197, 3 clinicians

Practice addresses (Care Compare)

1601 NW Hawthorne Ave
Grants Pass, OR 97526-1041
Phone (541) 472-4880

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
89000337RNORMDRegistered Nurse
200460004CRNAORMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Rogue Anesthesia LLC CurrentSince Sep 1, 2015 Accepting new patients
Anesthesia Healthcare Partners, Inc. Nurse Anesthetist, Certified Registered Past Accepting new patients
MCV Associated Physicians PastSince Sep 28, 2021 Accepting new patients

Locations

400 10th St E
Waconia, MN 55387

658 N Main St
Ashland, OR 97520
Phone (541) 324-2813

120 NE Manzanita Ave
Grants Pass, OR 97526
Phone (541) 476-6636

1601 NW Hawthorne Ave
Grants Pass, OR 97526
Phone (541) 472-4880

1353 E McAndrews Rd
Medford, OR 97504
Phone (541) 770-6776

1408 E Barnett Rd
Medford, OR 97504
Phone (503) 779-2464

280 S Pacific Hwy
Talent, OR 97540
Phone (541) 500-4199

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1135296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363910400000",
    "number": "1073590733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2620 EAST BARNETT RD",
            "address_2": "SUITE H",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "97504",
            "telephone_number": "541-789-5250",
            "fax_number": "541-789-5538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 SW RAMSEY AVE",
            "city": "GRANTS PASS",
            "state": "OR",
            "postal_code": "97527",
            "telephone_number": "541-472-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "KEITH",
        "middle_name": "ROBERT",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-23",
        "last_updated": "2013-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "89000337RN",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OR",
            "license": "200460004CRNA",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grants Pass, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2013; 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.