Individual provider Active NPI

Nit Khamvongs, CRNA

  • Certified Registered Nurse Anesthetist
  • Vero Beach, FL
National Provider Identifier
1316038532
Registry record updated Jun 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
ARNP9232218 Issued in FL
Practice address
3500 US Highway 1
Vero Beach, FL 32960-4511
Phone
(772) 299-1404
Fax
(772) 299-1455
NPI assigned
Sep 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X ARNP9232218 FL Primary
Nurse Practitioner 363L00000X 9232218 FL

Addresses

Primary practice location

3500 US Highway 1
Vero Beach, FL 32960-4511

Mailing address

3500 US Highway 1
Vero Beach, FL 32960-4511
Phone (772) 299-1404

Other identifiers 1

IdentifierTypeStateIssuer
307376900MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100526000594 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 0547351785 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Port St Lucie Anesthesia LLCGroup PAC ID 2769743343, 4 clinicians
Treasure Coast Anesthesia Group PAGroup PAC ID 2567600588, 98 clinicians

Practice addresses (Care Compare)

1715 SE Tiffany Ave
Port St Lucie, FL 34952-7511
Phone (772) 335-7005

200 SE Hospital Ave
Stuart, FL 34994-2346
Phone (772) 287-5200

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9232218FLMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
William J. Mallon, MD CurrentSince Jun 23, 2021 Accepting new patients
Sheridan Healthcorp, Inc. CurrentSince Oct 10, 2013 Accepting new patients
Indian River Health Services Inc CurrentSince Oct 1, 2019 Accepting new patients
Treasure Coast Anesthesia Group PA Nurse Anesthetist, Certified Registered CurrentSince May 30, 2020 Accepting new patients
Port St Lucie Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2019 Accepting new patients
Sheridan Healthcorp Inc Nurse Anesthetist, Certified Registered Current Accepting new patients
Amsurg Citrus Anesthesia LLC CurrentSince Jul 15, 2019 Accepting new patients
Sheridan Healthcorp Inc Nurse Anesthetist, Certified Registered CurrentSince Oct 10, 2013 Accepting new patients
Indian River Health Services Inc CurrentSince Oct 1, 2019 Accepting new patients

Locations

4500 Newberry Rd
Gainesville, FL 32607
Phone (352) 367-2310

2861 Delaney Ave
Ste A
Orlando, FL 32806
Phone (407) 472-5095

401 NW 42nd Ave
Plantation, FL 33317
Phone (954) 513-6434

1715 SE Tiffany Ave
Port St Lucie, FL 34952
Phone (772) 335-3939

2100 SE Salerno Rd
Stuart, FL 34997
Phone (772) 223-2300

200 SE Hospital Ave
Stuart, FL 34994
Phone (772) 223-5618

1613 NW 136th Ave
Ste 200
Sunrise, FL 33323
Phone (954) 838-2502

1000 36th St
Ste 244
Vero Beach, FL 32960
Phone (772) 778-9621

1000 36th St
Vero Beach, FL 32960
Phone (772) 567-1942

3500 US Highway 1
Vero Beach, FL 32960
Phone (772) 202-6625

1190 37th St
Vero Beach, FL 32960
Phone (772) 563-4666

Organizations & group practices 9

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1624406400000",
    "number": "1316038532",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3500 US HIGHWAY 1",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329604511",
            "telephone_number": "772-299-1404",
            "fax_number": "772-299-1455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3500 US HIGHWAY 1",
            "city": "VERO BEACH",
            "state": "FL",
            "postal_code": "329604511",
            "telephone_number": "772-299-1404",
            "fax_number": "772-299-1455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KHAMVONGS",
        "first_name": "NIT",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-27",
        "last_updated": "2021-06-23",
        "certification_date": "2021-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "FL",
            "license": "ARNP9232218",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "FL",
            "license": "9232218",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "307376900",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Vero Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2021; 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.