Active NPI
Kenneth Richard Kannenberg, CRNA
- Certified Registered Nurse Anesthetist
- Boise, ID
National Provider Identifier
1174579692
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- RNA406
- Practice address
- 1055 N Curtis Rd
Boise, ID 83706-1352 - Phone
- (208) 367-6416
- NPI assigned
- May 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | N27389 | ID | |
| Certified Registered Nurse Anesthetist | 367500000X | RNA406 | ID | Primary |
Addresses
Primary practice location
1055 N Curtis Rd
Boise, ID 83706-1352
Mailing address
PO Box 4268
Portland, OR 97208-4268
Phone (503) 372-2740
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 805750900 | Medicaid | ID | |
| 430066232 | Other | ID | RAILROAD MEDICARE |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| N27389 | ID | MD | Registered Nurse |
| RNA406 | ID | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Boise Anesthesia, PA | Past | Accepting new patients | |
| Boise Anesthesia, P a | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
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.
-
- Anesthesiology Physician
- Boise, ID
- NPI 1487602298
Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Boise, ID
- NPI 1740239599
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302134400000",
"number": "1174579692",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 4268",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972084268",
"telephone_number": "503-372-2740",
"fax_number": "503-372-2754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1055 N CURTIS RD",
"city": "BOISE",
"state": "ID",
"postal_code": "837061352",
"telephone_number": "208-367-6416"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANNENBERG",
"first_name": "KENNETH",
"middle_name": "RICHARD",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-26",
"last_updated": "2011-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "ID",
"license": "N27389",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "ID",
"license": "RNA406",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "805750900",
"state": "ID"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "430066232",
"state": "ID"
}
],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 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.