Active NPI
Kevin G Pickens, CRNA
- Certified Registered Nurse Anesthetist
- Rolla, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 149842
- Practice address
- 1000 W 10TH St
Rolla, MO 65401-2905 - Phone
- (573) 458-8899
- NPI assigned
- Jan 26, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 149842 | MO | Primary |
Addresses
Primary practice location
1000 W 10TH St
Rolla, MO 65401-2905
Mailing address
PO Box 220
Rolla, MO 65402-0220
Phone (573) 458-8899
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 916006901 | Medicaid | MO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ID
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2325 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 557-2700
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mountain View Hospital LLC | Current | Accepting new patients | |
| Mountain View Hospital LLC | Current | Accepting new patients | |
| Phelps County Regional Medical Center | Current | Accepting new patients | |
| Missouri Valley Anesthesia, PC | Past | Accepting new patients | |
| Mymichigan Medical Center Tawas | Past | Accepting new patients |
Locations
2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686
1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000
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.
-
- General Acute Care Hospital
- Idaho Falls, ID
- NPI 1669462362
-
- General Acute Care Hospital
- Rolla, MO
- NPI 1891766051
-
- Pain Medicine Physician
- Pocatello, ID
- NPI 1699141150
-
- Anesthesiology Physician
- Washington, MO
- NPI 1720040165
-
- Rural Health Clinic/Center
- Tawas City, MI
- NPI 1952399743
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Idaho Falls, ID
- NPI 1114481447
-
- General Acute Care Hospital
- Idaho Falls, ID
- NPI 1669462362
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138233600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1558331843",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 220",
"city": "ROLLA",
"state": "MO",
"postal_code": "654020220",
"telephone_number": "573-458-8899"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 W 10TH ST",
"city": "ROLLA",
"state": "MO",
"postal_code": "654012905",
"telephone_number": "573-458-8899"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PICKENS",
"first_name": "KEVIN",
"middle_name": "G",
"name_prefix": "Mr.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-26",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MO",
"license": "149842",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "916006901",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.