Individual provider Active NPI

Michael J Kettenring, CRNA

  • Certified Registered Nurse Anesthetist
  • Pensacola, FL
National Provider Identifier
1578702841
Registry record updated Nov 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
ARNP9164781 Issued in FL
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

Updated by the provider on Nov 11, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
592-06446OtherALBLUE CROSS BLUE SHIELD
00784800MedicaidFL
G4768OtherFLBLUE CROSS BLUE SHIELD
108987MedicaidAL
P00730365OtherMEDICARE RAILROAD

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090421000387 FL Practitioner - Certified Registered Nurse Anesthetist (Crna) 4981751484 Reassigns benefits to 4 organizations

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
Capital Anesthesia Solutions of Florida II, LLCGroup PAC ID 7911323720, 327 clinicians
Ams Anesthetist Services LLCGroup PAC ID 8325298458, 149 clinicians

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

LicenseStateTypeSpecialty
ARNP9164781FLMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Sheridan Healthcorp Inc Nurse Anesthetist, Certified Registered Current Accepting new patients
Sheridan Healthcorp Inc Nurse Anesthetist, Certified Registered CurrentSince Aug 16, 2015 Accepting new patients
Ams Sacred Heart LLC CurrentSince Dec 1, 2015 Accepting new patients
Ams Anesthetist Services LLC Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2012 Accepting new patients
Sheridan Healthcorp, Inc. CurrentSince Aug 16, 2015 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.

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": "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.

Verify at the official NPI Registry.