NPIMap

Organization Active NPI

Vision Anesthesia LLC

  • Anesthesiology Physician
  • Jacksonville, FL
National Provider Identifier
1134740319
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
VISION ANESTHESIA LLC
Practice address
9726 Touchton Rd Ste 305
Jacksonville, FL 32246-8307
Phone
(904) 686-6020
Fax
(904) 619-8879
NPI assigned
Apr 29, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Authorized official

Name
Kirby Kitchens, CRNANPI 1013021690
Title
Member/Manager
Phone
(941) 360-1566

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

9726 Touchton Rd Ste 305
Jacksonville, FL 32246-8307

Mailing address

PO Box 4485
Dept 1200
Houston, TX 77210-4485
Phone (941) 360-1566

Other practice location 1

100 Gavotte Ln
Anderson, SC 29621-8205
Phone (864) 261-7474

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, GA2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20200601001043 FL Part B Supplier - Clinic/Group Practice 0648691592 Receives reassigned benefits from 79 practitioners
Practice locations: Fort Myers, FL; Jacksonville, FL; Lake City, FL; Winter Garden, FL
O20210428000240 GA Part B Supplier - Clinic/Group Practice 0648691592 Receives reassigned benefits from 77 practitioners
Practice locations: Statesboro, GA; Savannah, GA; Marietta, GA; Macon, GA; Johns Creek, GA; Stockbridge, GA; Thomasville, GA; Tucker, GA…

National Provider Directory

National Provider Directory

Locations

803 N Jackson St
#B
Albany, GA 31701
Phone (229) 431-2260

2311 Lake Park Dr
Albany, GA 31707
Phone (229) 435-0525

531 7th Ave
Albany, GA 31701
Phone (229) 883-3535

227 Riverstone Dr
Canton, GA 30114
Phone (770) 720-7733

158 Clinic Ave
Carrollton, GA 30117
Phone (770) 834-1008

1468 Montreal Rd
Ste 200
Tucker, GA 30084
Phone (770) 638-1400

2003 Alice St
Ste B
Waycross, GA 31501
Phone (912) 283-7596

Practitioners & affiliated clinicians

Practitioners 151

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 151

NPI Registry JSON

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

{
    "created_epoch": "1588118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1134740319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 4485",
            "address_2": "DEPT 1200",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "772104485",
            "telephone_number": "941-360-1566",
            "fax_number": "941-358-9818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9726 TOUCHTON RD STE 305",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322468307",
            "telephone_number": "904-686-6020",
            "fax_number": "904-619-8879"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "100 Gavotte Ln",
            "address_purpose": "LOCATION",
            "city": "Anderson",
            "state": "SC",
            "postal_code": "296218205",
            "country_code": "US",
            "telephone_number": "864-261-7474",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "VISION ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-29",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A",
        "authorized_official_last_name": "KITCHENS",
        "authorized_official_first_name": "KIRBY",
        "authorized_official_title_or_position": "MEMBER/MANAGER",
        "authorized_official_telephone_number": "941-360-1566",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.