Kelly J Fiack, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

RNA133018 Issued in ME

Practice address

489 State St
Bangor, ME 04401-6616

Phone

(207) 992-4032

Fax

(207) 992-4034

NPI assigned

Jun 28, 2013

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

Medicare fee-for-service enrollment

Enrolled in AZ

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Anesthesia Partners and Management LLCGroup PAC ID 9931429198, 151 clinicians

Guide Anesthesia Az LLCGroup PAC ID 1355846106, 102 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wickenburg Community Hospital Hospital, Wickenburg, AZ, CCN 031300
• Flagstaff Medical Center Hospital, Flagstaff, AZ, CCN 030023
• The Core Institute Specialty Hosp Hospital, Phoenix, AZ, CCN 030108

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.

• Anesthesia Partners & Management LLC

  • Certified Registered Nurse Anesthetist
  • Brighton, MI
  • NPI 1336530997

  AZ, Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Guide Anesthesia Az LLC

  • Certified Registered Nurse Anesthetist
  • Phoenix, AZ
  • NPI 1649164849

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD
• Anesthesia Partners of Arizona LLC

  • Anesthesiology Physician
  • Richardson, TX
  • NPI 1619452901

  AZ

  Medicare reassignment NPD
• Ascend Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Mesa, AZ
  • NPI 1407642945

  Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• True North Anesthesia L.L.C.

  • Certified Registered Nurse Anesthetist
  • Bangor, ME
  • NPI 1194176040

  Nurse Anesthetist, Certified Registered

  NPD (past)
• Arizona Post-Acute Medical Services 1 PC

  • Hospitalist Physician
  • Phoenix, AZ
  • NPI 1093254419
  NPD (past)

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

• Community Hospital Association, Inc.

  • Critical Access Hospital
  • Wickenburg, AZ
  • NPI 1841282852
  Care Compare affiliation
• Flagstaff Medical Center

  • Air Ambulance
  • Flagstaff, AZ
  • NPI 1427234111

  Hospital

  Care Compare affiliation
• Flagstaff Medical Center

  • Land Ambulance
  • Flagstaff, AZ
  • NPI 1518143205

  Hospital

  Care Compare affiliation
• Flagstaff Medical Center

  • Psychiatric Hospital Unit
  • Flagstaff, AZ
  • NPI 1649370875
  Care Compare affiliation
• Flagstaff Medical Center

  • General Acute Care Hospital
  • Flagstaff, AZ
  • NPI 1780635078
  Care Compare affiliation
• Surgical Specialty Hospital of Arizona, LLC

  • Special Hospital
  • Phoenix, AZ
  • NPI 1902881295
  Care Compare affiliation

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

{
    "created_epoch": "1372377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372377600000",
    "number": "1669812111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 N MAIN ST STE 205",
            "city": "BREWER",
            "state": "ME",
            "postal_code": "044122055",
            "telephone_number": "207-992-4032",
            "fax_number": "207-992-4034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "489 STATE ST",
            "city": "BANGOR",
            "state": "ME",
            "postal_code": "044016616",
            "telephone_number": "207-992-4032",
            "fax_number": "207-992-4034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FIACK",
        "first_name": "KELLY",
        "middle_name": "J",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-06-28",
        "last_updated": "2013-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ME",
            "license": "RNA133018",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori J Ferguson, LCSW
• Gary Warren Fessler, DDS
• Erin Jodrey Fetzer, MD
• Sandra J. Feverston, R.PH.
• Rebecca Dawn Fevurly, M.D.
• Charles Fichera
• Susan Fickett, OTR
• Lisa Anne Fidler, LCSW
• Elizabeth Ives Field, CCC-SLP
• Tracey Field, CADC

• Certified Registered Nurse Anesthetist in Bangor, ME
• Providers in Bangor, ME by specialty
• Certified Registered Nurse Anesthetist in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2013; 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.