Individual provider Active NPI

Shannon Joseph Krumm, CRNA

  • Certified Registered Nurse Anesthetist
  • Pella, IA
National Provider Identifier
1801855713
Registry record updated Nov 5, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
103187 Issued in IA
Practice address
404 Jefferson St
Pella, IA 50219-1291
Phone
(641) 628-6634
Fax
(816) 461-6586
NPI assigned
Mar 20, 2006
Last updated
Nov 5, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 103187 IA Primary

Addresses

Primary practice location

404 Jefferson St
Pella, IA 50219-1291

Mailing address

PO Box 1660
Independence, MO 64055-0660
Phone (816) 461-8288

Other identifiers 1

IdentifierTypeStateIssuer
0206516MedicaidIA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
36797KYMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Associates of Kansas City PA Past Accepting new patients
Robert H and Teresita S Petty Past Accepting new patients
Gregory L Hummel MD PC Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1142812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194220800000",
    "number": "1801855713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1660",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640550660",
            "telephone_number": "816-461-8288",
            "fax_number": "816-461-6586"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "404 JEFFERSON ST",
            "city": "PELLA",
            "state": "IA",
            "postal_code": "502191291",
            "telephone_number": "641-628-6634",
            "fax_number": "816-461-6586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUMM",
        "first_name": "SHANNON",
        "middle_name": "JOSEPH",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-20",
        "last_updated": "2007-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IA",
            "license": "103187",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0206516",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pella, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.