Kristopher Caleb Pack

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

97394 Issued in WV

Practice address

100 Angus E Peyton Dr
South Charleston, WV 25303-1600

Phone

(304) 746-2088

NPI assigned

Apr 5, 2022

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 WV

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Northstar Anesthesia of West Virginia PLLCGroup PAC ID 2668750241, 124 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Cabell Huntington Hospital, Inc Hospital, Huntington, WV, CCN 510055

Medicare enrollment (NPD)

Enrolled

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.

• Northstar Anesthesia of West Virginia, PLLC

  • Anesthesiology Physician
  • Irving, TX
  • NPI 1821448150

  Nurse Anesthetist, Certified Registered, WV

  Medicare reassignment Care Compare group NPD

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

• Cabell Huntington Hospital Inc

  • General Acute Care Hospital
  • Huntington, WV
  • NPI 1073518007
  Care Compare affiliation

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

{
    "created_epoch": "1649116800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1750022463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1575 ARNOLD CT",
            "city": "HUNTINGTON",
            "state": "WV",
            "postal_code": "257052909",
            "telephone_number": "304-673-9546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 ANGUS E PEYTON DR",
            "city": "SOUTH CHARLESTON",
            "state": "WV",
            "postal_code": "253031600",
            "telephone_number": "304-746-2088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACK",
        "first_name": "KRISTOPHER",
        "middle_name": "CALEB",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-05",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WS0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, School",
            "state": "WV",
            "license": "97394",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "WV",
            "license": "97394",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aspen Otten-Schlinger
• Cecily Overton
• Stephanie Overton
• Gabrielle Owens
• Susan Ann Owens
• Heaven Padgett
• Haley Grace Page
• Shania Page
• Lashey Anyece Palmer
• Panucci & Jackfert Orthodontics, Inc.

• Certified Registered Nurse Anesthetist in South Charleston, WV
• Providers in South Charleston, WV by specialty
• Certified Registered Nurse Anesthetist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; 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.