Individual provider Active NPI

Kealanalani R Thompson, M.D.

  • Emergency Medicine Physician
  • Las Vegas, NV
National Provider Identifier
1124057443
Registry record updated Jan 21, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
MD12769 Issued in HI
Practice address
500 N Rainbow Blvd
Suite 203
Las Vegas, NV 89107-1082
Phone
(702) 259-1228
Fax
(702) 259-1252
NPI assigned
Jun 30, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 21, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X MD12769 HI Primary
Emergency Medical Services (Emergency Medicine) Physician 207PE0004X 12506 NV

Addresses

Primary practice location

500 N Rainbow Blvd
Suite 203
Las Vegas, NV 89107-1082

Mailing address

500 N Rainbow Blvd
Suite 203
Las Vegas, NV 89107-1082
Phone (702) 259-1228

Other identifiers 1

IdentifierTypeStateIssuer
55426301MedicaidHI

Other names 1

  • Kealanalani R Richards Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080516000228 NV Practitioner - Emergency Medicine 3173424793 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD12769HIMDEmergency Medicine Physician
12506NVMDEmergency Medical Services (Emergency Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Shadow Emergency Physicians PLLC Emergency Medicine CurrentSince Nov 1, 2011 Accepting new patients
Shadow Emergency Physicians PLLC Emergency Medicine CurrentSince Nov 1, 2011 Accepting new patients
The Emergency Group, Inc. Emergency Medicine Past Accepting new patients
Doctors Medical Services, Emcare Past Accepting new patients
Valley Hospital Medical Center Past Accepting new patients

Locations

620 Shadow Ln
Las Vegas, NV 89106
Phone (702) 388-4506

5400 S Rainbow Blvd
Las Vegas, NV 89118
Phone (702) 252-7342

Organizations & group practices 5

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": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1421798400000",
    "number": "1124057443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "500 N RAINBOW BLVD",
            "address_2": "SUITE 203",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891071082",
            "telephone_number": "702-259-1228",
            "fax_number": "702-259-1252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N RAINBOW BLVD",
            "address_2": "SUITE 203",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891071082",
            "telephone_number": "702-259-1228",
            "fax_number": "702-259-1252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "KEALANALANI",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2015-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "HI",
            "license": "MD12769",
            "primary": true
        },
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "NV",
            "license": "12506",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "55426301",
            "state": "HI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEALANALANI",
            "last_name": "RICHARDS",
            "middle_name": "R",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Las Vegas, NV

Sources for this page

Verify at the official NPI Registry.