Roger O Kennedy, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

C236 Issued in AR

Practice address

1100 E Poplar St
Clarksville, AR 72830-4419

Phone

(479) 754-5454

Fax

(479) 754-5311

NPI assigned

Aug 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AR

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1977

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Johnson Regional Medical CenterGroup PAC ID 1658360284, 16 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Johnson Regional Medical Center Hospital, Clarksville, AR, CCN 040002

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• Johnson Regional Medical Center

  • Anesthesiology Physician
  • Clarksville, AR
  • NPI 1396794525
  Medicare reassignment Care Compare group NPD
• Johnson Regional Medical Center

  • Land Ambulance
  • Clarksville, AR
  • NPI 1275753881
  NPD
• Arkansas Methodist Hospital Corporation

  • Ambulance
  • Paragould, AR
  • NPI 1578633368
  NPD (past)
• Gregory L Hummel MD PC

  • Orthopaedic Surgery Physician
  • Independence, MO
  • NPI 1942377320
  NPD (past)
• Robert H and Teresita S Petty

  • Anesthesiology Physician
  • Effingham, IL
  • NPI 1306913868
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Johnson Regional Medical Center

  • General Acute Care Hospital
  • Clarksville, AR
  • NPI 1134116049
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1659484848",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 738",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728300738",
            "telephone_number": "479-754-5454",
            "fax_number": "479-754-5311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 E POPLAR ST",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728304419",
            "telephone_number": "479-754-5454",
            "fax_number": "479-754-5311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KENNEDY",
        "first_name": "ROGER",
        "middle_name": "O",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "AR",
            "license": "C236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BX INDIVIDUAL PROVIDER #",
            "identifier": "59486",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amelia Yvonne Hanes Jones
• Jess E Jordan, APRN
• Camille Judy
• Brooklynn Justice, RECOVERY ASSISTANT
• Erika Keene, CMP
• Robert Terry Kerbs, D.C., C.C.E.P.
• Kerry Carlson DDS,PLLC
• Deanna Keylon
• Rebecca Keylon
• Derek Killane

• Certified Registered Nurse Anesthetist in Clarksville, AR
• Providers in Clarksville, AR by specialty
• Certified Registered Nurse Anesthetist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.