Kelly Bacon
Individual provider Active NPI Certified Registered Nurse Anesthetist · Idabel, OK
NPI 1700844313 · NPPES record last updated Oct 26, 2021
Key facts
- NPI
- 1700844313
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- R0071221 (OK)
- Practice address
- 1301 E Lincoln Rd
Idabel, OK 74745-7300 - Phone
- (580) 286-7623
- NPI assigned
- May 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 2
Medicare Care Compare profile
- 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 PLLC
Practice addresses (Care Compare)
3701 E Main St
Weatherford Regional Hospital
Weatherford, OK 73096-3309
Phone (580) 772-5551
430 N Monte Vista St
Mercy Hospital Ada
Ada, OK 74820-4610
Phone (580) 332-2323
Hospital & facility affiliations
- Mercy Hospital Ada
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OK
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20211101001542 | OK | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 6103710470 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R0071221 | OK | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| St Anthony Shawnee Hospital Inc | Current |
Accepting new patients | |
| St. Anthony Shawnee Hospital, Inc. | Current |
Accepting new patients | |
| Western Oklahoma Anesthesia Consultants PLLC | Current |
Accepting new patients |
Locations
7106 Solutions Ctr
Chicago, IL 60677
430 N Monte Vista St
Ada, OK 74820
Phone (580) 226-1251
1800 Renaissance Blvd
Edmond, OK 73013
Phone (405) 359-2400
1710 W 3rd St
Ste 100
Elk City, OK 73644
Phone (580) 255-1555
1801 W 3rd St
Elk City, OK 73644
Phone 5802255403677
1 E Clark Bass Blvd
McAlester, OK 74501
Phone (918) 421-6941
4 E Clark Bass Blvd
McAlester, OK 74501
Phone (918) 421-6700
2825 Parklawn Dr
Oklahoma City, OK 73110
Phone (405) 245-1453
401 SW 80th St
Ste 200
Oklahoma City, OK 73139
Phone (405) 601-4227
2401 W Wrangler Blvd
Seminole, OK 74868
Phone (405) 303-4000
1102 W MacArthur St
Shawnee, OK 74804
Phone (405) 273-2270
3701 E Main St
Weatherford, OK 73096
Phone (580) 772-5551
900 17th St
Woodward, OK 73801
Phone (405) 610-4411
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiologist Assistant | 367H00000X | R0071221 | OK | |
| Certified Registered Nurse Anesthetist | 367500000X | R0071221 | OK | Yes |
Addresses
Primary practice location
1301 E Lincoln Rd
Idabel, OK 74745-7300
Mailing address
PO Box 1547
Sedalia, MO 65302-1547
Phone (660) 826-5960
Other providers in Idabel, OK
- Hampton W Anderson III
- Karen D Andrews
- Ardeshir F. Nia, MD, PC
- Matthew Kasey Ashlock
- Glenda Austin
- Yolanda Renee Bailey
- Terri Lynn Baker
- Lisa A Baracker
- Christie Dawn Barton
- Wendy M Barton
All providers in Idabel, OK · Certified Registered Nurse Anesthetist in Oklahoma
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 26, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.