Active NPI
Kevin Liebrum, CRNA
- Certified Registered Nurse Anesthetist
- Anderson, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 28154851
- Practice address
- 1515 N Madison Ave
Anderson, IN 46011-3453 - Phone
- (317) 802-6302
- NPI assigned
- Nov 16, 2005
- Last updated
- Dec 8, 2022
- 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 | 28154851 | IN | Primary |
Addresses
Primary practice location
1515 N Madison Ave
Anderson, IN 46011-3453
Mailing address
6626 E 75TH St
Suite 500
Indianapolis, IN 46250-2805
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200387980 | Medicaid | IN |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kliebrum7778@eCommunityDirect.com | Community Physicians of Indiana Inc |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
7150 Clearvista Dr
Indianapolis, IN 46256-1695
Phone (317) 621-6262
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28154851 | IN | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Community Physicians of Indiana Inc | Current | Accepting new patients | |
| Community Physicians of Indiana Inc | Current | Accepting new patients | |
| Hendricks County Anesthesiology, P.C. | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
| Wabash Valley Anesthesia | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
| Westview Anesthesia Group, LLC | Past | Accepting new patients |
Locations
5819 Reliable Pkwy
Chicago, IL 60686
1515 N Madison Ave
Anderson, IN 46011
Phone (317) 870-0488
1000 E Main St
Danville, IN 46122
Phone (317) 745-3420
1500 N Ritter Ave
Indianapolis, IN 46219
Phone (317) 355-5041
3630 Guion Rd
Indianapolis, IN 46222
Phone (317) 920-7170
6626 E 75th St
Ste 500
Indianapolis, IN 46250
Phone (317) 621-7547
7120 Clearvista Dr
Ste 4000
Indianapolis, IN 46256
Phone (317) 621-7444
7150 Clearvista Dr
Indianapolis, IN 46256
Phone (317) 355-5041
8075 N Shadeland Ave
Indianapolis, IN 46250
Phone (317) 621-8000
1402 E County Line Rd
Southport, IN 46227
Phone (317) 887-7000
Interoperability endpoints
- kliebrum7778@ecommunitydirect.com
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.
-
- Family Medicine Physician
- Indianapolis, IN
- NPI 1619105244
-
dba Community Physician Network
- Endocrinology, Diabetes & Metabolism Physician
- Carmel, IN
- NPI 1992396337
-
- Anesthesiology Physician
- Danville, IN
- NPI 1629029277
Nurse Anesthetist, Certified Registered
-
- Certified Registered Nurse Anesthetist
- Noblesville, IN
- NPI 1720023799
Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Indianapolis, IN
- NPI 1780634147
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132099200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1670457600000",
"number": "1649252586",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6626 E 75TH ST",
"address_2": "SUITE 500",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462502805"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1515 N MADISON AVE",
"city": "ANDERSON",
"state": "IN",
"postal_code": "460113453",
"telephone_number": "317-802-6302"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LIEBRUM",
"first_name": "KEVIN",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-16",
"last_updated": "2022-12-08",
"certification_date": "2022-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "IN",
"license": "28154851",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200387980",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kliebrum7778@eCommunityDirect.com",
"affiliation": "Y",
"affiliationName": "Community Physicians of Indiana Inc",
"address_1": "1515 N Madison Ave",
"city": "Anderson",
"state": "IN",
"country_code": "US",
"postal_code": "460113453",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Anderson, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; 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.