Phanthavong Boon, RN, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

24179395 Issued in VA

Practice address

650 Huebner Rd
Fort Riley, KS 66442-4030

Phone

(785) 239-7000

NPI assigned

Nov 22, 2005

Last updated

Feb 16, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Enrolled in KS, OR, VA3 enrollments

Enrollment records 3

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Santiam Memorial HospitalGroup PAC ID 6103729751, 128 clinicians

Premier Anesthesia of Oregon PCGroup PAC ID 2961857123, 30 clinicians

Anesthesia Associates Northwest LLCGroup PAC ID 7618908484, 80 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence Willamette Falls Medical Center Hospital, Oregon City, OR, CCN 380038
• Santiam Hospital & Clinics Hospital, Stayton, OR, CCN 380056
• Providence Newberg Medical Center Hospital, Newberg, OR, CCN 380037

Merit-based Incentive Payment System (MIPS)

Final score

78.15 of 100Reported as group

Quality

74.3

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse, Registered Nurse

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Anesthesia Associates Northwest LLC

  • Anesthesiology Physician
  • Milwaukie, OR
  • NPI 1548281751
  Medicare reassignment Care Compare group NPD
• Premier Anesthesia of Oregon PC

  • Anesthesiology Physician
  • Newberg, OR
  • NPI 1154010429
  Medicare reassignment Care Compare group NPD
• Santiam Memorial Hospital

  • General Acute Care Hospital
  • Stayton, OR
  • NPI 1154302214
  Medicare reassignment Care Compare group NPD
• Sweet Dreams Anesthesia Inc

  • Certified Registered Nurse Anesthetist
  • Chattanooga, TN
  • NPI 1508133497

  KS, Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Anesthesia Associates of Topeka PA

  • Anesthesiology Physician
  • Topeka, KS
  • NPI 1518933837
  Medicare reassignment
• Santiam Memorial Hospital

  dba Santiam Women's Clinic

  • Medical Specialty Clinic/Center
  • Stayton, OR
  • NPI 1063731271
  NPD
• Santiam Memorial Hospital

  dba Santiam Health & Wellness Clinic

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Stayton, OR
  • NPI 1801787171
  NPD

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

• Providence Health & Services - Oregon

  dba Providence Medical Group

  • Clinic/Center
  • Portland, OR
  • NPI 1326272741

  Hospital

  Care Compare affiliation
• Providence Health & Services - Oregon

  dba Providence Willamette Falls Medical Center

  • General Acute Care Hospital
  • Oregon City, OR
  • NPI 1912282369
  Care Compare affiliation
• Providence Health & Services - Oregon

  dba Providence Newberg Medical Center

  • General Acute Care Hospital
  • Newberg, OR
  • NPI 1952482275
  Care Compare affiliation
• Santiam Memorial Hospital

  • General Acute Care Hospital
  • Stayton, OR
  • NPI 1154302214
  Care Compare affiliation
• Santiam Memorial Hospital

  • Ambulance
  • Stayton, OR
  • NPI 1962566752

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644969600000",
    "number": "1184607285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 HUEBNER RD",
            "city": "FORT RILEY",
            "state": "KS",
            "postal_code": "664424030",
            "telephone_number": "785-239-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 HUEBNER RD",
            "city": "FORT RILEY",
            "state": "KS",
            "postal_code": "664424030",
            "telephone_number": "785-239-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOON",
        "first_name": "PHANTHAVONG",
        "name_prefix": "Mr.",
        "credential": "RN, CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-22",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KS",
            "license": "43-557812-072",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "24179395",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OR",
            "license": "202201644RN",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KS",
            "license": "14-153121-072",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "VA",
            "license": "0001186892",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anetta Blevins, PSY.D.
• Andrew David Bloom, M.D.
• Jeffrey G Blue, MD
• Claudia R Bodway, PHD
• Karli Ann Boober
• Jamie Bowling
• Anna Miquel Boyer, M.S., CCC-SLP
• Peggy Brillant
• Margaret Ellen Brockson, ARNP
• Beverly N Brown, CRNP

• Certified Registered Nurse Anesthetist in Fort Riley, KS
• Providers in Fort Riley, KS by specialty
• Certified Registered Nurse Anesthetist in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2022; 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.