Individual provider Active NPI

John Matthew Fant

  • Certified Registered Nurse Anesthetist
  • Owensboro, KY
National Provider Identifier
1336504208
Registry record updated Dec 30, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3009983 Issued in KY
Practice address
1201 Pleasant Valley Rd
Owensboro, KY 42303-9811
Phone
(270) 417-2000
NPI assigned
Dec 21, 2015
Last updated
Dec 30, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2015

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 3009983 KY Primary
Registered Nurse 163W00000X 161179 TN

Addresses

Primary practice location

1201 Pleasant Valley Rd
Owensboro, KY 42303-9811

Mailing address

6225 N State Highway 161
Ste #200
Irving, TX 75038-2223
Phone (214) 687-0001

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160108002130 KY Practitioner - Certified Registered Nurse Anesthetist (Crna) 9133421019 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ohio County Hospital CorporationGroup PAC ID 3577477264, 84 clinicians
Anesthesia Dynamics LLCGroup PAC ID 3779832530, 883 clinicians

Practice addresses (Care Compare)

1211 Old Main St
Hartford, KY 42347-1619
Phone (270) 298-7411

217 S 3Rd St
Danville, KY 40422-1823
Phone (853) 893-1000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
161179TNMDRegistered Nurse
3009983KYMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Dynamics LLC Nurse Anesthetist, Certified Registered CurrentSince Dec 17, 2024 Accepting new patients
Ad of Kentucky PLLC Nurse Anesthetist, Certified Registered CurrentSince Sep 17, 2025 Accepting new patients
Northstar Anesthesia of Kentucky, PLLC Nurse Anesthetist, Certified Registered CurrentSince Jan 5, 2016 Accepting new patients
Commonwealth Anesthesia, PSC Nurse Anesthetist, Certified Registered CurrentSince Feb 5, 2024 Accepting new patients
Ohio County Hospital Corporation CurrentSince May 1, 2023 Accepting new patients
Ohio County Hospital Corporation Nurse Anesthetist, Certified Registered CurrentSince May 1, 2023 Accepting new patients

Locations

217 S 3rd St
Danville, KY 40422
Phone (859) 239-1000

1211 Old Main St
Hartford, KY 42347
Phone (270) 298-3806

20 E McMurtry Ave
Hartford, KY 42347
Phone (270) 504-1300

310 S Limestone
Lexington, KY 40508
Phone (606) 252-6612

225 Abraham Flexner Way
Ste 700
Louisville, KY 40202
Phone (502) 562-0398

1099 Medical Center Cir
Mayfield, KY 42066
Phone (270) 251-4100

1000 Breckenridge St
Ste 100
Owensboro, KY 42303
Phone (270) 683-2751

1201 Pleasant Valley Rd
Owensboro, KY 42303
Phone (270) 417-2000

6225 State Highway 161
Ste 200
Irving, TX 75038
Phone (214) 687-0496

Organizations & group practices 6

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.

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": "1450656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1451433600000",
    "number": "1336504208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6225 N STATE HIGHWAY 161",
            "address_2": "STE #200",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750382223",
            "telephone_number": "214-687-0001",
            "fax_number": "972-518-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1201 PLEASANT VALLEY RD",
            "city": "OWENSBORO",
            "state": "KY",
            "postal_code": "423039811",
            "telephone_number": "270-417-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FANT",
        "first_name": "JOHN",
        "middle_name": "MATTHEW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-12-21",
        "last_updated": "2015-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KY",
            "license": "3009983",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "TN",
            "license": "161179",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Owensboro, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2015; 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.