Individual provider Active NPI

Keith A Wanner, CRNA

  • Certified Registered Nurse Anesthetist
  • Watertown, SD
National Provider Identifier
1114178159
Registry record updated Oct 8, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
CR000711 Issued in SD
Practice address
401 9TH Ave NW
Watertown, SD 57201-1548
Phone
(605) 882-7000
Fax
(605) 882-7819
NPI assigned
Oct 8, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2008

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 CR000711 SD Primary

Addresses

Primary practice location

401 9TH Ave NW
Watertown, SD 57201-1548

Mailing address

401 9TH Ave NW
Watertown, SD 57201-1548
Phone (605) 882-7000

Other identifiers 1

IdentifierTypeStateIssuer
CR000711OtherSDCRNA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081230000042 SD Practitioner - Certified Registered Nurse Anesthetist (Crna) 7012079098 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prairie Lakes Health Care System IncGroup PAC ID 8628987823, 111 clinicians

Practice addresses (Care Compare)

401 9TH Ave NW
Watertown, SD 57201-1548
Phone (605) 882-7000

Hospital & facility affiliations

  • Prairie Lakes Healthcare System, Inc Hospital, Watertown, SD, CCN 430005

Merit-based Incentive Payment System (MIPS)

Final score
94.59 of 100Reported as group
Quality
100
Promoting interoperability
96
Improvement activities
40
Cost
85.3

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Prairie Lakes Health Care System Inc CurrentSince Sep 22, 2008 Accepting new patients
Prairie Lakes Health Care System Inc CurrentSince Sep 22, 2008 Accepting new patients
Ikare Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2024 Accepting new patients

Locations

824 N 11th St
Montevideo, MN 56265
Phone (320) 269-8877

310 8th Ave NW
Ste 508
Aberdeen, SD 57401

905 N 3rd St
Aberdeen, SD 57401
Phone (605) 226-2108

401 9th Ave NW
Watertown, SD 57201
Phone (605) 886-9317

1201 Mickelson Dr
Watertown, SD 57201
Phone (605) 882-0432

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1223424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223424000000",
    "number": "1114178159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 9TH AVE NW",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572011548",
            "telephone_number": "605-882-7000",
            "fax_number": "605-882-7819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 9TH AVE NW",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572011548",
            "telephone_number": "605-882-7000",
            "fax_number": "605-882-7819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WANNER",
        "first_name": "KEITH",
        "middle_name": "A",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-10-08",
        "last_updated": "2008-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "SD",
            "license": "CR000711",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRNA",
            "identifier": "CR000711",
            "state": "SD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Watertown, SD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2008; 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.