Individual provider Active NPI

Kennett Bruce Murdock

  • Certified Registered Nurse Anesthetist
  • Boise, ID
National Provider Identifier
1629772371
Registry record updated Oct 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
75617 Issued in ID
Practice address
1055 N Curtis Rd
Boise, ID 83706-1309
Phone
(208) 367-6416
Fax
(208) 367-2742
NPI assigned
Mar 28, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2023

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 75617 ID Primary

Addresses

Primary practice location

1055 N Curtis Rd
Boise, ID 83706-1309

Mailing address

PO Box 190930
Boise, ID 83719-0930
Phone (208) 367-5170

Other practice location 1

801 Pole Line Rd W
Twin Falls, ID 83301-5810
Phone (208) 737-2000

Other practice location 2

4300 E Flamingo Ave
Nampa, ID 83687-3138
Phone (208) 367-6416

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230524002370 ID Practitioner - Certified Registered Nurse Anesthetist (Crna) 6608232293 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mountain View Hospital LLCGroup PAC ID 4486562774, 272 clinicians

Practice addresses (Care Compare)

2325 Coronado St
Idaho Falls, ID 83404-7407
Phone (208) 557-2700

Hospital & facility affiliations

  • Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065
  • Idaho Falls Community Hospital, LLC Hospital, Idaho Falls, ID, CCN 130074

Merit-based Incentive Payment System (MIPS)

Final score
85.09 of 100Reported as group
Quality
77.1
Promoting interoperability
100
Improvement activities
40
Cost
73.19

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
St Alphonsus Professional Medical Services LLC CurrentSince Nov 1, 2023 Accepting new patients
Mountain View Hospital LLC CurrentSince Apr 1, 2024 Accepting new patients
St Alphonsus Professional Medical Services LLC CurrentSince Nov 1, 2023 Accepting new patients
St Luke'S Magic Valley Regional Medical Center LTD Past Accepting new patients

Locations

1055 N Curtis Rd
Boise, ID 83706
Phone (208) 367-2152

2325 Coronado St
Idaho Falls, ID 83404
Phone (208) 528-7686

4300 E Flamingo Ave
Nampa, ID 83687
Phone (208) 205-1000

Interoperability endpoints

  • Direct secure messaging: kmurdock3055639@direct.trinity-health.org

Organizations & group practices 4

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 2

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": "1679961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698192000000",
    "number": "1629772371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 190930",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837190930",
            "telephone_number": "208-367-5170",
            "fax_number": "208-367-5180"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1055 N CURTIS RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837061309",
            "telephone_number": "208-367-6416",
            "fax_number": "208-367-2742"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "801 Pole Line Rd W",
            "address_purpose": "LOCATION",
            "city": "Twin Falls",
            "state": "ID",
            "postal_code": "833015810",
            "country_code": "US",
            "telephone_number": "208-737-2000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4300 E Flamingo Ave",
            "address_purpose": "LOCATION",
            "city": "Nampa",
            "state": "ID",
            "postal_code": "836873138",
            "country_code": "US",
            "telephone_number": "208-367-6416",
            "fax_number": "208-367-2742",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MURDOCK",
        "first_name": "KENNETT",
        "middle_name": "BRUCE",
        "name_prefix": "Mr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-03-28",
        "last_updated": "2023-10-25",
        "certification_date": "2023-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ID",
            "license": "75617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Boise, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2023; 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.