Active NPI
Thomas J Kavanaugh, CRNA
- Certified Registered Nurse Anesthetist
- West Allis, WI
National Provider Identifier
1235287509
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 1154-33
- Practice address
- 8901 W. Lincoln Ave
Aurora West Allis Medical Center
West Allis, WI 53227 - Phone
- (414) 328-6000
- Fax
- (414) 328-8536
- NPI assigned
- Jan 5, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 1154-33 | WI | Primary |
Addresses
Primary practice location
8901 W. Lincoln Ave
Aurora West Allis Medical Center
West Allis, WI 53227
Mailing address
8901 W. Lincoln Ave
Aurora West Allis Medical Center
West Allis, WI 53227
Phone (414) 328-6000
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| KAVANTHO | Other | WI | MERCYCARE |
| 43284100 | Medicaid | WI |
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
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1154-33 | WI | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Stoughton Hospital Association | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Critical Access Hospital
- Stoughton, WI
- NPI 1679558647
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167955200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1475798400000",
"number": "1235287509",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8901 W. LINCOLN AVE",
"address_2": "AURORA WEST ALLIS MEDICAL CENTER",
"city": "WEST ALLIS",
"state": "WI",
"postal_code": "53227",
"telephone_number": "414-328-6000",
"fax_number": "414-328-8536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8901 W. LINCOLN AVE",
"address_2": "AURORA WEST ALLIS MEDICAL CENTER",
"city": "WEST ALLIS",
"state": "WI",
"postal_code": "53227",
"telephone_number": "414-328-6000",
"fax_number": "414-328-8536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KAVANAUGH",
"first_name": "THOMAS",
"middle_name": "J",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-05",
"last_updated": "2016-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "WI",
"license": "1154-33",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MERCYCARE",
"identifier": "KAVANTHO",
"state": "WI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "43284100",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Allis, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.