Individual provider Active NPI

Kevin Liebrum, CRNA

  • Certified Registered Nurse Anesthetist
  • Anderson, IN
National Provider Identifier
1649252586
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
28154851 Issued in IN
Practice address
1515 N Madison Ave
Anderson, IN 46011-3453
Phone
(317) 802-6302
NPI assigned
Nov 16, 2005
Last updated
Dec 8, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

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 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

IdentifierTypeStateIssuer
200387980MedicaidIN

Electronic endpoints 1

TypeEndpointUseAffiliation
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

Enrollment IDStateProvider typePAC IDDetails
I20040219000572 IN Practitioner - Certified Registered Nurse Anesthetist (Crna) 6709771553 Reassigns benefits to 1 organization

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
Community Physicians of Indiana IncGroup PAC ID 1759416662, 1,569 clinicians

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

LicenseStateTypeSpecialty
28154851INMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Physicians of Indiana Inc CurrentSince Jul 1, 2012 Accepting new patients
Community Physicians of Indiana Inc CurrentSince Jul 1, 2012 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

  • Direct secure messaging: 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.

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.

Verify at the official NPI Registry.