Active NPI
Jerry Clarkson, CRNA
- Certified Registered Nurse Anesthetist
- Pratt, KS
National Provider Identifier
1558339010
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 54408
- Practice address
- 200 Commodore St
Pratt, KS 67124-2903 - Phone
- (620) 672-7451
- Fax
- (316) 652-0340
- NPI assigned
- Mar 10, 2006
- Last updated
- Oct 4, 2011
- Sex
- Male
- Sole proprietor
- Yes
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 | 54408 | KS | Primary |
Addresses
Primary practice location
200 Commodore St
Pratt, KS 67124-2903
Mailing address
PO Box 1919
Wichita, KS 67201-1919
Phone (316) 685-3698
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 012137 | Other | KS | BCBS |
| 100143840C | Medicaid | KS | |
| 200029270A | Medicaid | OK | |
| 430001730 | Other | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cancer Center of Kansas, P.a. | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Hematology & Oncology Physician
- Wichita, KS
- NPI 1841251394
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1141948800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317686400000",
"number": "1558339010",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1919",
"city": "WICHITA",
"state": "KS",
"postal_code": "672011919",
"telephone_number": "316-685-3698",
"fax_number": "316-652-0340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 COMMODORE ST",
"city": "PRATT",
"state": "KS",
"postal_code": "671242903",
"telephone_number": "620-672-7451",
"fax_number": "316-652-0340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARKSON",
"first_name": "JERRY",
"credential": "CRNA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-03-10",
"last_updated": "2011-10-04",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "KS",
"license": "54408",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "012137",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100143840C",
"state": "KS"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200029270A",
"state": "OK"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "430001730",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Pratt, KS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.