Sundance Zxaine Kemp, CAA

Primary specialty

Anesthesiologist AssistantTaxonomy code 367H00000X

License

75000098A Issued in IN

Practice address

2401 W University Ave
Muncie, IN 47303-3499

Phone

(765) 747-3111

NPI assigned

Dec 25, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in IN, SC, TX3 enrollments

Enrollment records 3

Specialty

Anesthesiology Assistant

Education

Indiana University School of Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Iu Health Medical Group LLCGroup PAC ID 9638617913, 4,382 clinicians

Indiana University Health Ball Memorial Physicians IncGroup PAC ID 9537072640, 286 clinicians

Austin Anesthesiology Group PLLCGroup PAC ID 0547256497, 430 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Indiana University Health Ball Memorial Hospital Hospital, Muncie, IN, CCN 150089
• St David'S Medical Center Hospital, Austin, TX, CCN 450431
• North Austin Medical Center Hospital, Austin, TX, CCN 450809

Medicare enrollment (NPD)

Enrolled

Credentials

Associate of Arts

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sundancekemp@direct.iuhealth.org

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.

• Indiana University Health Ball Memorial Physicians, Inc.

  • Family Medicine Physician
  • Muncie, IN
  • NPI 1235455544
  Medicare reassignment Care Compare group NPD
• Iu Health Medical Group, LLC

  • General Practice Physician
  • Indianapolis, IN
  • NPI 1326893777
  Medicare reassignment Care Compare group NPD
• Austin Anesthesiology Group, PLLC

  • Anesthesiology Physician
  • Austin, TX
  • NPI 1598724304

  Anesthesiologist Assistant

  Medicare reassignment Care Compare group NPD
• Anesthesia Associates of Rock Hill, P.a.

  • Anesthesiology Physician
  • Rock Hill, SC
  • NPI 1811977200
  Medicare reassignment NPD
• Austin Anesthesiology Group PLLC

  • Anesthesiology Physician
  • Bryan, TX
  • NPI 1528326154
  NPD

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

• Indiana University Health Ball Memorial Hospital, Inc.

  • General Acute Care Hospital
  • Muncie, IN
  • NPI 1225195340
  Care Compare affiliation
• St Davids Healthcare Partnership LP LLP

  • General Acute Care Hospital
  • Austin, TX
  • NPI 1629021845
  Care Compare affiliation
• St. Davids Healthcare Partnership, L.P., LLP

  • General Acute Care Hospital
  • Austin, TX
  • NPI 1720033947
  Care Compare affiliation

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

{
    "created_epoch": "1640390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693267200000",
    "number": "1679233118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 N SHADELAND AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462194959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 W UNIVERSITY AVE",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473033499",
            "telephone_number": "765-747-3111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7 Independence Pt Ste 300",
            "address_purpose": "LOCATION",
            "city": "Greenville",
            "state": "SC",
            "postal_code": "296154569",
            "country_code": "US",
            "telephone_number": "864-522-3700",
            "fax_number": "864-522-3705",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KEMP",
        "first_name": "SUNDANCE",
        "middle_name": "ZXAINE",
        "credential": "CAA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-12-25",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "SC",
            "license": "TL95",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "IN",
            "license": "75000098A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "M22404254",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "SC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sundancekemp@direct.iuhealth.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "2401 W University Ave",
            "city": "Muncie",
            "state": "IN",
            "country_code": "US",
            "postal_code": "473033499",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kay Ann Keller, LMHC
• Ericka Kelley
• Holly Kelley, RBT
• Moses Kelly III, MSW, MS, M.ED.,
• Beth Marie Kelsey, NP
• Taylor R Kennedy, SLP
• Kenneth J Patterson DDS LLC
• Megan Kenworthy
• Brittany S Kern, MD
• Lisa Kerr, PTA

• Anesthesiologist Assistant in Muncie, IN
• Providers in Muncie, IN by specialty
• Anesthesiologist Assistant in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 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.