Individual provider Active NPI

Keith S Ewer, CRNA

  • Certified Registered Nurse Anesthetist
  • Cabot, AR
National Provider Identifier
1104916113
Registry record updated Jul 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
C00270 Issued in AR
Practice address
474 Southwood Cir
Cabot, AR 72023-8917
Phone
(501) 843-5858
NPI assigned
Oct 13, 2006
Last updated
Jul 19, 2011By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 19, 2011

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 C00270 AR Primary

Addresses

Primary practice location

474 Southwood Cir
Cabot, AR 72023-8917

Mailing address

474 Southwood Circle
Cabot, AR 72023-8917
Phone (501) 843-5858

Other identifiers 1

IdentifierTypeStateIssuer
121464701MedicaidAR

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
C00270ARMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Dyersburg Hospital Company LLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Anesthesiology Services LTD Past Accepting new patients
Anesthesia Partners PLLC Nurse Anesthetist, Certified Registered Past Accepting new patients
Conway Anesthesiology Consultants, P.a. PastSince Mar 1, 2020 Accepting new patients
Anesthesia and Pain Management Assoc., P.a. Past Accepting new patients
Rebsamen Anesthesia Inc Nurse Anesthetist, Certified Registered Past Accepting new patients
Kennebec Anesthesia Associates, P.a. Past Accepting new patients

Organizations & group practices 7

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": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1311033600000",
    "number": "1104916113",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "474 SOUTHWOOD CIRCLE",
            "city": "CABOT",
            "state": "AR",
            "postal_code": "720238917",
            "telephone_number": "501-843-5858"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "474 SOUTHWOOD CIR",
            "city": "CABOT",
            "state": "AR",
            "postal_code": "720238917",
            "telephone_number": "501-843-5858"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EWER",
        "first_name": "KEITH",
        "middle_name": "S",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2011-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "C00270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121464701",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cabot, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2011; 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.