Timothy Paul Kordick, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

2004031215 Issued in MO

Practice address

2620 N Westwood Blvd
Poplar Bluff, MO 63901-3396

Phone

(573) 686-4111

NPI assigned

Apr 4, 2008

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Rural Health Pain Management LLCGroup PAC ID 8921410341, 35 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Poplar Bluff Regional Medical Center Hospital, Poplar Bluff, MO, CCN 260119

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

Practice roles

Locations

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.

• Rural Health Pain Management LLC

  • Pain Medicine (Anesthesiology) Physician
  • Forrest City, AR
  • NPI 1265039556

  MO

  Medicare reassignment Care Compare group NPD
• Capital Anesthesia Solutions of Missouri, LLC

  • Anesthesiology Physician
  • Rombauer, MO
  • NPI 1770185472
  Medicare reassignment NPD
• Clinical Colleagues Inc

  • Anesthesiology Physician
  • Van Wert, OH
  • NPI 1992725766

  MO, Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Poplar Bluff Regional Medical Center LLC

  • General Acute Care Hospital
  • Poplar Bluff, MO
  • NPI 1700831724

  Nurse Anesthetist, Certified Registered

  NPD (past)
• Poplar Bluff Regional Medical Center LLC

  • Rural Health Clinic/Center
  • Malden, MO
  • NPI 1801839147
  NPD (past)

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

• Poplar Bluff Regional Medical Center LLC

  • General Acute Care Hospital
  • Poplar Bluff, MO
  • NPI 1700831724
  Care Compare affiliation

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

{
    "created_epoch": "1207267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207267200000",
    "number": "1174796601",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 88",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639020088",
            "telephone_number": "573-727-2724",
            "fax_number": "573-727-2788"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2620 N WESTWOOD BLVD",
            "city": "POPLAR BLUFF",
            "state": "MO",
            "postal_code": "639013396",
            "telephone_number": "573-686-4111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORDICK",
        "first_name": "TIMOTHY",
        "middle_name": "PAUL",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-04-04",
        "last_updated": "2008-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2004031215",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kneibert Clinic LLC
• Kneibert Clinic LLC
• Ann C Kneibert, LPC
• Lorie Leigh Kolwyck
• Geetha R Komatireddy, MD
• Kramer Family Vision
• Edward Patrick Kreulen, FNP
• Charles S. Krin, D.O.
• Miranda Krishna, NP-C
• Balamurugan G Krishnan, M.D.

• Certified Registered Nurse Anesthetist in Poplar Bluff, MO
• Providers in Poplar Bluff, MO by specialty
• Certified Registered Nurse Anesthetist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 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.