Individual provider Active NPI

Kelly B. Smith, CRNA

  • Certified Registered Nurse Anesthetist
  • Shawnee Mission, KS
National Provider Identifier
1821065319
Registry record updated Nov 24, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
55125 Issued in KS
Practice address
9100 W 74TH St
Shawnee Mission, KS 66204-4004
Phone
(913) 632-2230
Fax
(913) 632-2297
NPI assigned
Mar 2, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 24, 2020

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 1482828061 KS
Certified Registered Nurse Anesthetist 367500000X 55125 KS Primary

Addresses

Primary practice location

9100 W 74TH St
Shawnee Mission, KS 66204-4004

Mailing address

PO Box 411895
Kansas City, MO 64141-1895
Phone (913) 632-2230

Other identifiers 4

IdentifierTypeStateIssuer
P00032006OtherKSRR MEDICARE
32813018OtherKSBCBS KC
100457780AMedicaidKS
918965401MedicaidMO

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040630000380 KS Practitioner - Certified Registered Nurse Anesthetist (Crna) 9638156425 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
University of Missouri, Kansas City, School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Midwest Anesthesia Associates, PAGroup PAC ID 4981597838, 89 clinicians

Practice addresses (Care Compare)

9100 W 14TH St
Shawnee Mission, KS 66204-4004
Phone (913) 632-2230

Hospital & facility affiliations

  • Adventhealth Shawnee Mission Hospital, Shawnee Mission, KS, CCN 170104

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1482828061KSMDRegistered Nurse
55125KSMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Midwest Anesthesia Associates, PA Registered Nurse CurrentSince Jul 1, 2003 Accepting new patients

Locations

9100 W 74th St
Shawnee Msn, KS 66204
Phone (913) 632-2230

9301 W 74th St
Ste 300
Shawnee Msn, KS 66204
Phone (913) 632-9300

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 and National Provider Directory roles.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1141257600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606176000000",
    "number": "1821065319",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 411895",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641411895",
            "telephone_number": "913-632-2230",
            "fax_number": "913-632-2297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9100 W 74TH ST",
            "city": "SHAWNEE MISSION",
            "state": "KS",
            "postal_code": "662044004",
            "telephone_number": "913-632-2230",
            "fax_number": "913-632-2297"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "KELLY",
        "middle_name": "B.",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-02",
        "last_updated": "2020-11-24",
        "certification_date": "2020-11-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "KS",
            "license": "1482828061",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "KS",
            "license": "55125",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00032006",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS KC",
            "identifier": "32813018",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100457780A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "918965401",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Shawnee Mission, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 24, 2020; 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.