NPIMap

Individual provider Active NPI

Glenn A. Kunkel, MD

  • Anesthesiology Physician
  • Rolla, MO
National Provider Identifier
1598761231
Registry record updated Nov 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
113756 Issued in MO
Practice address
1000 W 10TH St
Rolla, MO 65401-2905
Phone
(573) 458-8899
Fax
(573) 341-5611
NPI assigned
Jun 27, 2005
Last updated
Nov 2, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine Physician 208VP0000X 113756 MO
Anesthesiology Physician 207L00000X 113756 MO Primary
Specialist 174400000X 113756 MO

Addresses

Primary practice location

1000 W 10TH St
Rolla, MO 65401-2905

Mailing address

P.O. Box 1216
Rolla, MO 65402
Phone (573) 364-2200

Other practice location 1

1050 W. 10th Street
Suite 330
Rolla, MO 65401
Phone (573) 364-2200

Other identifiers 1

IdentifierTypeStateIssuer
209664002MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040421000725 MO Practitioner - Pain ManagementPractitioner - Anesthesiology 0840285029 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Pain ManagementAlso: Anesthesiology
Education
University of Cincinnati College of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1000 W 10TH St
Phelps Health
Rolla, MO 65401-2905
Phone (573) 458-8899

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Spinal fusion1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
113756MOMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Ameripath Indianapolis PC Current Accepting new patients
Pcrmc Medical Group, Inc CurrentSince Dec 9, 2024 Accepting new patients
Ozarks Medical Center Pain Medicine Past Accepting new patients

Locations

1050 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1000 W 10th St
Rolla, MO 65401
Phone (573) 364-9000

1050 W 10th St
Ste 330
Rolla, MO 65401
Phone (573) 364-2200

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1119830400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698883200000",
    "number": "1598761231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 1216",
            "city": "ROLLA",
            "state": "MO",
            "postal_code": "65402",
            "telephone_number": "573-364-2200",
            "fax_number": "573-364-7600"
        },
        {
            "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",
            "fax_number": "573-341-5611"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1050 W. 10th Street",
            "address_2": "Suite 330",
            "address_purpose": "LOCATION",
            "city": "Rolla",
            "state": "MO",
            "postal_code": "65401",
            "country_code": "US",
            "telephone_number": "573-364-2200",
            "fax_number": "573-364-7600",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KUNKEL",
        "first_name": "GLENN",
        "middle_name": "A.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-27",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "MO",
            "license": "113756",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "113756",
            "primary": true
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MO",
            "license": "113756",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "209664002",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Rolla, MO

Sources for this page

Verify at the official NPI Registry.