Active NPI
Kathryn Kanner, MD
- Psychiatry Physician
- Phoenix, AZ
National Provider Identifier
1730319104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 45045
- Practice address
- 1430 E Missouri Ave Ste B100
Phoenix, AZ 85014-2480 - Phone
- (602) 883-2318
- Fax
- (877) 992-9257
- NPI assigned
- Jul 20, 2009
- Last updated
- Nov 7, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 45045 | AZ | Primary |
Addresses
Primary practice location
1430 E Missouri Ave Ste B100
Phoenix, AZ 85014-2480
Mailing address
1430 E Missouri Ave Ste B100
Phoenix, AZ 85014-2480
Phone (602) 883-2318
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 624357 | Medicaid | AZ |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Dec 6, 2017 through Dec 6, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 45045 | AZ | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dignity Health | Past | Accepting new patients |
Organizations & group practices 1
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.
-
dba Mercy Medical Center Redding
- General Acute Care Hospital
- Redding, CA
- NPI 1477671535
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248048000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667779200000",
"number": "1730319104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1430 E MISSOURI AVE STE B100",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850142480",
"telephone_number": "602-883-2318",
"fax_number": "877-992-9257"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1430 E MISSOURI AVE STE B100",
"city": "PHOENIX",
"state": "AZ",
"postal_code": "850142480",
"telephone_number": "602-883-2318",
"fax_number": "877-992-9257"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KANNER",
"first_name": "KATHRYN",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-07-20",
"last_updated": "2022-11-07",
"certification_date": "2022-11-07",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "AZ",
"license": "45045",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "624357",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Phoenix, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.