Individual provider Active NPI

Kenneth Bates, CRNA

  • Certified Registered Nurse Anesthetist
  • Stillwater, OK
National Provider Identifier
1174632152
Registry record updated Mar 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
120925 Issued in OK
Practice address
1323 W 6TH Ave
Stillwater, OK 74074-4306
Phone
(405) 372-1480
NPI assigned
Aug 30, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 120925 OK Primary
Certified Registered Nurse Anesthetist 367500000X 1380744092 KS

Addresses

Primary practice location

1323 W 6TH Ave
Stillwater, OK 74074-4306

Mailing address

PO Box 720006
Norman, OK 73070-4006
Phone (405) 372-1480

Other practice location 1

1700 SW 7th St
Topeka, KS 66606-1674
Phone (785) 295-8111

Other identifiers 1

IdentifierTypeStateIssuer
0000145009OtherKSBLUE CROSS OF KS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170420000203 OK Practitioner - Certified Registered Nurse Anesthetist (Crna) 3274515184 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Stillwater Medical Center AuthorityGroup PAC ID 2365353794, 155 clinicians

Practice addresses (Care Compare)

417 Fairview Ave
Ponca City, OK 74601-1923
Phone (580) 762-3770

Hospital & facility affiliations

  • Stillwater Medical Center Hospital, Stillwater, OK, CCN 370049

Merit-based Incentive Payment System (MIPS)

Final score
90.91 of 100Reported as apm
Quality
76.55
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1380744092KSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Stillwater Medical Center Authority CurrentSince Feb 18, 2017 Accepting new patients
Stillwater Medical Center Authority CurrentSince Feb 18, 2017 Accepting new patients
Anesthesia Services Medical Group of Topeka, PA Past Accepting new patients
Anesthesia Services of Omaha LLC Past Accepting new patients

Locations

417 Fairview Ave
Ponca City, OK 74601
Phone (580) 762-3770

1323 W 6th Ave
Stillwater, OK 74074
Phone (405) 372-1480

Organizations & group practices 4

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583798400000",
    "number": "1174632152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 720006",
            "city": "NORMAN",
            "state": "OK",
            "postal_code": "730704006",
            "telephone_number": "405-372-1480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1323 W 6TH AVE",
            "city": "STILLWATER",
            "state": "OK",
            "postal_code": "740744306",
            "telephone_number": "405-372-1480"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1700 SW 7th St",
            "address_purpose": "LOCATION",
            "city": "Topeka",
            "state": "KS",
            "postal_code": "666061674",
            "country_code": "US",
            "telephone_number": "785-295-8111",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BATES",
        "first_name": "KENNETH",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2020-03-10",
        "certification_date": "2020-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OK",
            "license": "120925",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KS",
            "license": "1380744092",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF KS",
            "identifier": "0000145009",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Stillwater, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2020; 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.