Active NPI
Michael J Kettenring, CRNA
- Certified Registered Nurse Anesthetist
- Pensacola, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- ARNP9164781
- Practice address
- 4901 Grande Dr
Pensacola, FL 32504-5935 - Phone
- (850) 477-7042
- Fax
- (850) 474-9060
- NPI assigned
- Feb 11, 2009
- 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 | ARNP9164781 | FL | Primary |
Addresses
Primary practice location
4901 Grande Dr
Pensacola, FL 32504-5935
Mailing address
4901 Grande Dr
Pensacola, FL 32504-5935
Phone (850) 477-7042
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 592-06446 | Other | AL | BLUE CROSS BLUE SHIELD |
| 00784800 | Medicaid | FL | |
| G4768 | Other | FL | BLUE CROSS BLUE SHIELD |
| 108987 | Medicaid | AL | |
| P00730365 | Other | MEDICARE RAILROAD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
5151 N 9TH Ave
Pensacola, FL 32504-8721
Phone (850) 416-7000
540 The Rialto
Venice, FL 34285-2900
Phone (941) 485-7711
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ARNP9164781 | FL | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sheridan Healthcorp Inc | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Sheridan Healthcorp Inc | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Ams Sacred Heart LLC | Current | Accepting new patients | |
| Ams Anesthetist Services LLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Sheridan Healthcorp, Inc. | Current | Accepting new patients |
Locations
7800 US Highway 98 W
Miramar Beach, FL 32550
Phone (850) 267-1603
4600 SW 46th Ct
Ocala, FL 34474
Phone (352) 291-3000
5151 N 9th Ave
Pensacola, FL 32504
Phone (850) 202-4700
1613 NW 136th Ave
Ste 200
Sunrise, FL 33323
Phone (954) 838-2502
Organizations & group practices 6
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.
-
- Anesthesiology Physician
- Pensacola, FL
- NPI 1770834426
Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Naples, FL
- NPI 1891318481
-
- Anesthesiology Physician
- Pensacola, FL
- NPI 1457614851
-
- Anesthesiology Physician
- Okeechobee, FL
- NPI 1629781711
Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Ocala, FL
- NPI 1144995515
Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- North Miami Beach, FL
- NPI 1578429460
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Pensacola, FL
- NPI 1922032424
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1234310400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320969600000",
"number": "1578702841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4901 GRANDE DR",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325045935",
"telephone_number": "850-477-7042",
"fax_number": "850-474-9060"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4901 GRANDE DR",
"city": "PENSACOLA",
"state": "FL",
"postal_code": "325045935",
"telephone_number": "850-477-7042",
"fax_number": "850-474-9060"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETTENRING",
"first_name": "MICHAEL",
"middle_name": "J",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-02-11",
"last_updated": "2011-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "FL",
"license": "ARNP9164781",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "592-06446",
"state": "AL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00784800",
"state": "FL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "G4768",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "108987",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00730365",
"state": null
}
],
"endpoints": [],
"other_names": []
}
Other providers in Pensacola, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2011; 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.