Individual provider Active NPI

Kimberly Ronae Nadzam, CRNA

  • Certified Registered Nurse Anesthetist
  • Youngstown, OH
National Provider Identifier
1356663686
Registry record updated Oct 22, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
083420 Issued in OH
Practice address
3622 Belmont Ave
1
Youngstown, OH 44505-1450
Phone
(330) 759-9350
Fax
(330) 759-9387
NPI assigned
Mar 1, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 22, 2012

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 083420 OH Primary
Certified Registered Nurse Anesthetist 367500000X RN272694 OH

Addresses

Primary practice location

3622 Belmont Ave
1
Youngstown, OH 44505-1450

Mailing address

3622 Belmont Ave
1
Youngstown, OH 44505-1450
Phone (330) 759-9350

Other identifiers 2

IdentifierTypeStateIssuer
12105017OtherOHCAQH
3031703MedicaidOH

Other names 1

  • Kimberly Ronae Miller Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150922003176 OH Practitioner - Certified Registered Nurse Anesthetist (Crna) 5193852333 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
88.59 of 100Reported as group
Quality
83.4
Promoting interoperability
100
Improvement activities
40
Cost
78.58

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
083420OHMDCertified Registered Nurse Anesthetist
RN272694OHMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Gastroenterology Specialists Inc CurrentSince Jan 1, 2016 Accepting new patients
Northstar Anesthesia of Ohio LLC CurrentSince May 12, 2015 Accepting new patients
Gastroenterology Specialists Inc CurrentSince Jan 1, 2016 Accepting new patients
Associates in Anesthesiology, Inc Past Accepting new patients
Advanced Anesthesia Associates,Inc Past Accepting new patients

Locations

2726 Fulton Dr NW
Canton, OH 44718
Phone (330) 455-5011

2615 E High St
Springfield, OH 45505
Phone (888) 861-3994

Interoperability endpoints

  • FHIR API: https://a8580225-25d6-4812-a463-58e49a80f214.gastro.prod.fhir.ema-api.com/fhir/r4/

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1267401600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350864000000",
    "number": "1356663686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3622 BELMONT AVE",
            "address_2": "1",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445051450",
            "telephone_number": "330-759-9350",
            "fax_number": "330-759-9387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3622 BELMONT AVE",
            "address_2": "1",
            "city": "YOUNGSTOWN",
            "state": "OH",
            "postal_code": "445051450",
            "telephone_number": "330-759-9350",
            "fax_number": "330-759-9387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NADZAM",
        "first_name": "KIMBERLY",
        "middle_name": "RONAE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-01",
        "last_updated": "2012-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "083420",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OH",
            "license": "RN272694",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12105017",
            "state": "OH"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3031703",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KIMBERLY",
            "last_name": "MILLER",
            "middle_name": "RONAE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Youngstown, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2012; 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.