Kelly Renee Mangold, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

6708 Issued in NC

Practice address

3 Scarlet Oak CT
Lake St Louis, MO 63367-2130

Phone

(312) 919-6286

NPI assigned

Mar 12, 2010

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MO, NC, IN3 enrollments

Enrollment records 3

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Anesthesia Care Associates LLCGroup PAC ID 6608042288, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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.

• Anesthesia Care Associates, LLC

  • Certified Registered Nurse Anesthetist
  • South Bend, IN
  • NPI 1073899449

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Aim Anesthesia LLC

  • Anesthesiology Physician
  • Bridgetown, MO
  • NPI 1245685601
  Medicare reassignment NPD
• Anesthesia Stat LLC

  • Certified Registered Nurse Anesthetist
  • Florissant, MO
  • NPI 1467113357

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Dreamland Uap Anesthesia, LLC

  • Certified Registered Nurse Anesthetist
  • Hazelwood, MO
  • NPI 1073919494

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Jefferson City Medical Group, P.C.

  • Multi-Specialty Clinic/Center
  • Jefferson City, MO
  • NPI 1336189398
  Medicare reassignment NPD
• Novamed Eye Surgery Center of North County LLC

  • Certified Registered Nurse Anesthetist
  • Saint Louis, MO
  • NPI 1003260100

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• CPR Anesthesia, Inc

  • Anesthesiology Physician
  • Aurora, CO
  • NPI 1326436353

  MO, Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Northern Indiana Anesthesia Associates, LLC

  • Certified Registered Nurse Anesthetist
  • South Bend, IN
  • NPI 1033891510

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Northstar Anesthesia of Missouri, LLC

  • Anesthesiology Physician
  • Irving, TX
  • NPI 1396191789

  MO, Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Raleigh Sedation Associates LLC

  • Certified Registered Nurse Anesthetist
  • Raleigh, NC
  • NPI 1639698533

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Triad Sedation Associates, LLC

  • Certified Registered Nurse Anesthetist
  • Winston Salem, NC
  • NPI 1427528595

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Dreamy Time Inc

  • Certified Registered Nurse Anesthetist
  • Chesterfield, MO
  • NPI 1770255168

  Nurse Anesthetist, Certified Registered

  NPD

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

{
    "created_epoch": "1268352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687910400000",
    "number": "1477876803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 SCARLET OAK CT",
            "city": "LAKE ST LOUIS",
            "state": "MO",
            "postal_code": "633672130",
            "telephone_number": "312-919-6286"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 SCARLET OAK CT",
            "city": "LAKE ST LOUIS",
            "state": "MO",
            "postal_code": "633672130",
            "telephone_number": "312-919-6286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGOLD",
        "first_name": "KELLY",
        "middle_name": "RENEE",
        "name_prefix": "Ms.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-03-12",
        "last_updated": "2023-06-28",
        "certification_date": "2023-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2010005602",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "6708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "600420070",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://172.254.9.13:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.1",
            "affiliationName": "Bluemark LLC",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "40 Sunset Ridge Rd Ste 120",
            "city": "New Paltz",
            "state": "NY",
            "country_code": "US",
            "postal_code": "125611039",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Marisa Lynch, PA-C
• Brooke Rene Lyon, M.S., CCC-SLP
• Melissa Brooke Maer, PLPC
• Magna Care Services LLC
• Muhammad FS Malik, MD
• Mary McCann
• Barbara J McDowell, RN MSN CS APN
• Jean McHenry, CPM
• Kathleen A McNally, RN
• Medical Specialties, Inc.

• Certified Registered Nurse Anesthetist in Lake St Louis, MO
• Providers in Lake St Louis, MO by specialty
• Certified Registered Nurse Anesthetist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2023; 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.