Jonathan J Kidd, CNIM

Primary specialty

Electroneurodiagnostic Specialist/TechnologistTaxonomy code 246ZE0600X

Practice address

7746 Rannells Ave
Maplewood, MO 63143-1823

Phone

(217) 821-0759

Fax

(314) 552-7075

NPI assigned

May 7, 2007

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

Other names 1

• Jake Kidd Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• The Phoenix Oversight and Consulting, LLC.

  • Ambulatory Surgical Clinic/Center
  • Saint Louis, MO
  • NPI 1922574391
  NPD Authorized official
• Phoenix Ionm, LLC.

  • Ambulatory Surgical Clinic/Center
  • East Wenatchee, WA
  • NPI 1891357406
  NPD Authorized official
• NW Monitoring, LLC

  • Neurology Physician
  • Gig Harbor, WA
  • NPI 1679724827

  Electroneurodiagnostic

  NPD (past)

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

{
    "created_epoch": "1178496000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1295948560",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1737 W POWERS AVE",
            "city": "LITTLETON",
            "state": "CO",
            "postal_code": "801201209",
            "telephone_number": "217-821-0759",
            "fax_number": "314-552-7075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7746 RANNELLS AVE",
            "city": "MAPLEWOOD",
            "state": "MO",
            "postal_code": "631431823",
            "telephone_number": "217-821-0759",
            "fax_number": "314-552-7075"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1737 W Powers Ave",
            "address_purpose": "LOCATION",
            "city": "Littleton",
            "state": "CO",
            "postal_code": "801201209",
            "country_code": "US",
            "telephone_number": "217-821-0759",
            "fax_number": "314-552-7075",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KIDD",
        "first_name": "JONATHAN",
        "middle_name": "J",
        "credential": "CNIM",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-07",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "246ZE0600X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Electroneurodiagnostic",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAKE",
            "last_name": "KIDD",
            "credential": "CNIM",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Holistic Family Practice LLC
• Davontre Holland
• Susan Ignazito-Wilhelm, MAC, LPC
• J. W. H. Healthcare Services
• Rebecca Gould Karlen, DC
• Gregory Foster Kleinschmidt, D.C.
• Riley Marie Krus
• Edward Kutsar
• Barry Joseph Larson
• Rebekah May Larson, CIT

• All providers in Maplewood, MO
• Electroneurodiagnostic Specialist/Technologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.