Kelly Bacon

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

R0071221 Issued in OK

Practice address

1301 E Lincoln Rd
Idabel, OK 74745-7300

Phone

(580) 286-7623

NPI assigned

May 3, 2006

Last updated

Oct 26, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OK

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2003

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Western Oklahoma Anesthesia Consultants PLLCGroup PAC ID 4587924865, 15 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mercy Hospital Ada Hospital, Ada, OK, CCN 370020

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Western Oklahoma Anesthesia Consultants PLLC

  • Anesthesiology Physician
  • Elk City, OK
  • NPI 1881102614
  Medicare reassignment Care Compare group NPD
• St Anthony Shawnee Hospital Inc

  dba St Anthony Shawnee Hospital

  • Surgery Physician
  • Shawnee, OK
  • NPI 1619260411
  Medicare reassignment NPD
• St. Anthony Shawnee Hospital, Inc.

  dba SSM Health Pharmacy

  • Community/Retail Pharmacy
  • Shawnee, OK
  • NPI 1912739020
  NPD

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

• Mercy Hospital Ada, Inc

  • Ambulance
  • Ada, OK
  • NPI 1831533728

  Hospital

  Care Compare affiliation
• Mercy Hospital Ada, Inc

  dba Mercy Hospital Ada

  • General Acute Care Hospital
  • Ada, OK
  • NPI 1952643306
  Care Compare affiliation

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

{
    "created_epoch": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635206400000",
    "number": "1700844313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1547",
            "city": "SEDALIA",
            "state": "MO",
            "postal_code": "653021547",
            "telephone_number": "660-826-5960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 E LINCOLN RD",
            "city": "IDABEL",
            "state": "OK",
            "postal_code": "747457300",
            "telephone_number": "580-286-7623"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BACON",
        "first_name": "KELLY",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2021-10-26",
        "certification_date": "2021-10-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "OK",
            "license": "R0071221",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OK",
            "license": "R0071221",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hampton W Anderson III, D.O.
• Karen D Andrews, LBP
• Ardeshir F. Nia, MD, PC
• Matthew Kasey Ashlock
• Glenda Austin, B.S.
• Yolanda Renee Bailey
• Terri Lynn Baker
• Lisa A Baracker, DO
• Christie Dawn Barton
• Wendy M Barton

• Certified Registered Nurse Anesthetist in Idabel, OK
• Providers in Idabel, OK by specialty
• Certified Registered Nurse Anesthetist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2021; 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.