Individual provider Active NPI

Jordon Leigh Kliewer, CRNA

  • Certified Registered Nurse Anesthetist
  • Oklahoma City, OK
National Provider Identifier
1770006090
Registry record updated Jul 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
101050 Issued in OK
Practice address
920 Stanton L Young Blvd # Wp1140
Oklahoma City, OK 73104-5036
Phone
(405) 271-4351
Fax
(405) 271-8695
NPI assigned
Jul 18, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X R0101050 OK
Certified Registered Nurse Anesthetist 367500000X 101050 OK Primary

Addresses

Primary practice location

920 Stanton L Young Blvd # Wp1140
Oklahoma City, OK 73104-5036

Mailing address

PO Box 26901
Department of Anesthesiology
Oklahoma City, OK 73126-1039
Phone (405) 271-4351

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20171106000428 OK Practitioner - Certified Registered Nurse Anesthetist (Crna) 1254697410 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
R0101050OKMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Ou Health Partners, Inc CurrentSince Jan 6, 2022 Accepting new patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Sep 21, 2017 Accepting new patients
Hpi Physicians LLC CurrentSince Dec 31, 2020 Accepting new patients
Board of Regents of the University of Oklahoma - Ou Physicians CurrentSince Sep 21, 2017 Accepting new patients
Ou Health Partners, Inc CurrentSince Jan 6, 2022 Accepting new patients

Locations

1705 Renaissance Blvd
Ste 120
Edmond, OK 73013
Phone (405) 715-4496

920 Stanton L Young Blvd
#1140
Oklahoma City, OK 73104
Phone (405) 271-4515

920 Stanton L Young Blvd
Ste 1140
Oklahoma City, OK 73104

3100 SW 89th St
Oklahoma City, OK 73159
Phone (405) 602-8100

900 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-2230

14024 Quail Pointe Dr
Oklahoma City, OK 73134
Phone (405) 419-8447

920 Stanton L Young Blvd
Oklahoma City, OK 73104
Phone (405) 271-5251

825 NE 10th St
Oklahoma City, OK 73104
Phone (405) 271-4864

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1500336000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564012800000",
    "number": "1770006090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26901",
            "address_2": "DEPARTMENT OF ANESTHESIOLOGY",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731261039",
            "telephone_number": "405-271-4351",
            "fax_number": "405-271-8695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 STANTON L YOUNG BLVD # WP1140",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731045036",
            "telephone_number": "405-271-4351",
            "fax_number": "405-271-8695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLIEWER",
        "first_name": "JORDON",
        "middle_name": "LEIGH",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-07-18",
        "last_updated": "2019-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OK",
            "license": "R0101050",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OK",
            "license": "101050",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Oklahoma City, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.