NPIMap

Individual provider Active NPI

Kevin Immarri Hickman, CRNA

  • Certified Registered Nurse Anesthetist
  • Wilkes Barre, PA
National Provider Identifier
1306120779
Registry record updated Mar 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN810317 Issued in PA
Practice address
1000 E Mountain Dr
Wilkes Barre, PA 18711-0027
Phone
(570) 808-7850
Fax
(570) 808-7855
NPI assigned
Oct 4, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 9, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN810317 PA Primary

Addresses

Primary practice location

1000 E Mountain Dr
Wilkes Barre, PA 18711-0027

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 808-7850

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY, CA, PA3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20111004000450 NY Practitioner - Certified Registered Nurse Anesthetist (Crna) 7315119955 Reassigns benefits to 6 organizations
I20130523000194 CA Practitioner - Certified Registered Nurse Anesthetist (Crna) 7315119955 Reassigns benefits to 1 organization
I20260317002274 PA Practitioner - Certified Registered Nurse Anesthetist (Crna) 7315119955 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians
Weill Medical College of CornellGroup PAC ID 6800709023, 2,023 clinicians

Practice addresses (Care Compare)

1000 E Mountain Dr
Wilkes Barre, PA 18711-0001
Phone (570) 826-7850

525 E 68TH St
New York, NY 10065-4870
Phone (212) 746-2846

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4391CAMDSchool Psychologist
RN810317PAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Montefiore Medical Center CurrentSince Mar 4, 2018 Accepting new patients
Omni Anesthesia Associates, Inc. Nurse Anesthetist, Certified Registered CurrentSince Jun 22, 2013 Accepting new patients
Bronx Anesthesia Services, PC CurrentSince Apr 1, 2019 Accepting new patients
Geisinger-HM Joint Venture, LLC CurrentSince Mar 1, 2026 Accepting new patients
Igor Amigud Physician P.C. CurrentSince Mar 19, 2018 Accepting new patients
Weill Medical College of Cornell CurrentSince Jan 4, 2016 Accepting new patients
Geisinger Clinic CurrentSince Mar 1, 2026 Accepting new patients
Montefiore Medical Center CurrentSince Mar 4, 2018 Accepting new patients
Weill Medical College of Cornell Nurse Anesthetist, Certified Registered CurrentSince Jan 4, 2016 Accepting new patients
North American Partners in Anesthesia LLP CurrentSince Jul 1, 2016 Accepting new patients
Downtown Bronx Medical Associates PC CurrentSince Dec 13, 2023 Accepting new patients
Physician Affiliate Group of New York PC CurrentSince Sep 5, 2024 Accepting new patients
Geisinger-HM Joint Venture, LLC CurrentSince Mar 1, 2026 Accepting new patients
Geisinger Clinic CurrentSince Mar 1, 2026 Accepting new patients

Locations

445 S Cedar Ave
Fresno, CA 93702
Phone (559) 459-4000

7 Southwoods Blvd
Ste 4
Albany, NY 12211

111 E 210th St
Bronx, NY 10467

234 Eugenio Maria de Hosto Blvd
Bronx, NY 10451
Phone (718) 579-5874

1650 Grand Concourse
Bronx, NY 10457
Phone (718) 294-7104

4422 3rd Ave
Bronx, NY 10457
Phone (718) 960-3917

2601 Ocean Pkwy
Brooklyn, NY 11235
Phone (718) 616-5354

3122 Union St
Ste 1B
Flushing, NY 11354
Phone (718) 968-7171

7209 Buckley Rd
Liverpool, NY 13088
Phone (315) 299-5451

1510 Jericho Tpke
New Hyde Park, NY 11040
Phone (516) 216-5341

170 William St
New York, NY 10038
Phone (212) 238-0100

506 Malcolm X Blvd
New York, NY 10037
Phone (212) 939-1000

525 E 68th St
New York, NY 10065
Phone (212) 746-2846

300 Community Dr
Plandome, NY 11030

301 Prospect Ave
Syracuse, NY 13203
Phone (315) 448-5111

100 N Academy Ave
Danville, PA 17822

10 Choate Cir
Montoursville, PA 17754
Phone (570) 368-5566

1000 E Mountain Dr
Wilkes Barre, PA 18711
Phone (570) 826-7300

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H5989
  • Healthfirst Medicare Network H3359

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 25

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

View all 25

NPI Registry JSON

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

{
    "created_epoch": "1317686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773014400000",
    "number": "1306120779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-808-7850",
            "fax_number": "570-808-7855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 E MOUNTAIN DR",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110027",
            "telephone_number": "570-808-7850",
            "fax_number": "570-808-7855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HICKMAN",
        "first_name": "KEVIN",
        "middle_name": "IMMARRI",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-10-04",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN810317",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilkes Barre, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2026; 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.