Individual provider Active NPI

Kennedy Knox Sanders

  • Certified Registered Nurse Anesthetist
  • Toledo, OH
National Provider Identifier
1083385389
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
0020446 Issued in OH
Practice address
2142 N Cove Blvd
Toledo, OH 43606-3895
Phone
(419) 291-4000
NPI assigned
Sep 26, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

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 RN.429438 OH
Certified Registered Nurse Anesthetist 367500000X 0020446 OH Primary

Addresses

Primary practice location

2142 N Cove Blvd
Toledo, OH 43606-3895

Mailing address

8751 Sand Beach Rd
Oak Harbor, OH 43449-9748
Phone (419) 346-5700

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220211000430 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 9436542636 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Promedica Central PhysiciansGroup PAC ID 2365348190, 785 clinicians

Practice addresses (Care Compare)

2142 N Cove Blvd
Toledo, OH 43606-3895
Phone (419) 291-4000

Hospital & facility affiliations

  • Promedica Toledo Hospital Hospital, Toledo, OH, CCN 360068

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
RN.429438OHMDRegistered Nurse
0020446OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Feb 1, 2022 Accepting new patients
Promedica Central Physicians CurrentSince Feb 1, 2022 Accepting new patients

Locations

2142 N Cove Blvd
Toledo, OH 43606
Phone (419) 291-1111

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

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 and National Provider Directory roles.

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": "1632614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644451200000",
    "number": "1083385389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8751 SAND BEACH RD",
            "city": "OAK HARBOR",
            "state": "OH",
            "postal_code": "434499748",
            "telephone_number": "419-346-5700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2142 N COVE BLVD",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436063895",
            "telephone_number": "419-291-4000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDERS",
        "first_name": "KENNEDY",
        "middle_name": "KNOX",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-09-26",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OH",
            "license": "RN.429438",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "0020446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Toledo, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 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.