Individual provider Active NPI

Kenneth L. Hallwood, CRNA

  • Certified Registered Nurse Anesthetist
  • Mauston, WI
National Provider Identifier
1427039718
Registry record updated Nov 8, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
3626-33 Issued in WI
Practice address
1050 Division St
Mauston, WI 53948-1931
Phone
(608) 847-6161
NPI assigned
Nov 14, 2005
Last updated
Nov 8, 2019By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 8, 2019

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3626-33 WI
Certified Registered Nurse Anesthetist 367500000X 3626-33 WI Primary
Certified Registered Nurse Anesthetist 367500000X R148073-9 MN

Addresses

Primary practice location

1050 Division St
Mauston, WI 53948-1931

Mailing address

1050 Division St
Mauston, WI 53948-1931

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031205000675 WI Practitioner - Certified Registered Nurse Anesthetist (Crna) 9931004447 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vernon Memorial Healthcare IncGroup PAC ID 8325958416, 73 clinicians

Practice addresses (Care Compare)

507 S Main St
Viroqua, WI 54665-2059
Phone (608) 637-2101

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.7 of 100Reported as group
Quality
91.14
Promoting interoperability
100
Improvement activities
40
Cost
77.5

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R148073-9MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Divine Savior Healthcare, Inc. CurrentSince Dec 2, 2023 Accepting new patients
Divine Savior Healthcare, Inc. CurrentSince Dec 2, 2023 Accepting new patients
Mile Bluff Medical Center Inc CurrentSince Sep 1, 2003 Accepting new patients
Mile Bluff Medical Center Inc CurrentSince Oct 1, 2019 Accepting new patients
Vernon Memorial Healthcare, Inc. CurrentSince Aug 16, 2024 Accepting new patients
Mile Bluff Medical Center Inc Current Accepting new patients
Mile Bluff Medical Center Inc Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2003 Accepting new patients

Locations

29980 Network Pl
Chicago, IL 60673

1040 Division St
Mauston, WI 53948
Phone (608) 847-5000

1050 Division St
Mauston, WI 53948
Phone (608) 847-6161

2817 New Pinery Rd
Portage, WI 53901
Phone (608) 745-4598

507 S Main St
Viroqua, WI 54665
Phone (608) 637-2101

28 Commerce St
Wisconsin Dells, WI 53965
Phone (608) 254-5888

Interoperability endpoints

  • Direct secure messaging: khallwood881203@direct.emplifyhealth.org

Organizations & group practices 7

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": "1131926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573171200000",
    "number": "1427039718",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1050 DIVISION ST",
            "city": "MAUSTON",
            "state": "WI",
            "postal_code": "539481931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1050 DIVISION ST",
            "city": "MAUSTON",
            "state": "WI",
            "postal_code": "539481931",
            "telephone_number": "608-847-6161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HALLWOOD",
        "first_name": "KENNETH",
        "middle_name": "L.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-14",
        "last_updated": "2019-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "3626-33",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WI",
            "license": "3626-33",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R148073-9",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mauston, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2019; 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.