Individual provider Active NPI

Kevin James Cavanagh, CRNA

  • Certified Registered Nurse Anesthetist
  • Knoxville, TN
National Provider Identifier
1922376292
Registry record updated Dec 1, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
124994 Issued in TN
Practice address
501 20TH St
Suite 606
Knoxville, TN 37916-1809
Phone
(865) 546-8040
Fax
(865) 541-2787
NPI assigned
Dec 1, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 1, 2011

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 124994 TN Primary

Addresses

Primary practice location

501 20TH St
Suite 606
Knoxville, TN 37916-1809

Mailing address

501 20TH St
Suite 606
Knoxville, TN 37916-1809
Phone (865) 546-8040

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20121105000093 CT Practitioner - Certified Registered Nurse Anesthetist (Crna) 3072772961 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Lincoln Memorial University Medical Department, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Anesthesia Associates of Willimantic, PCGroup PAC ID 2163506353, 46 clinicians

Practice addresses (Care Compare)

1185 Main St
Willimantic, CT 06226-2093
Phone (860) 423-7558

Hospital & facility affiliations

  • Manchester Memorial Hospital Hospital, Manchester, CT, CCN 070027

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
Flagged The directory lists this NPI on an HHS exclusion list. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
124994TNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Associates of Willimantic PC CurrentSince Apr 18, 2016 Accepting new patients
Connecticut Gi PLLC CurrentSince Jul 1, 2022 Accepting new patients
American Anesthesiology of Tennessee, P.C. Nurse Anesthetist, Certified Registered Past Accepting new patients
American Anesthesiology of Tennessee, P.C. Past Accepting new patients
Litchfield County Gastroenterology Associates, LLC PastSince Jul 1, 2022 Accepting new patients

Locations

580 Cottage Grove Rd
Bloomfield, CT 06002
Phone (860) 243-8709

300 Western Blvd
Glastonbury, CT 06033
Phone (860) 547-0306

85 Seymour St
Ste 1000
Hartford, CT 06106
Phone (860) 246-2571

71 Haynes St
Manchester, CT 06040
Phone (860) 533-2981

37 Kennedy Dr
Ste C
Putnam, CT 06260
Phone (860) 423-7558

30 Waterchase Dr
Rocky Hill, CT 06067
Phone (860) 257-4131

2400 Tamarack Ave
Ste 100
South Windsor, CT 06074
Phone (860) 644-7336

31 Union St
Vernon Rockvl, CT 06066
Phone (860) 289-6451

1185 Main St
Willimantic, CT 06226
Phone (860) 423-7558

112 Mansfield Ave
Willimantic, CT 06226
Phone (830) 423-6410

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.

Hospital & facility affiliations 1

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": "1322697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1322697600000",
    "number": "1922376292",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 20TH ST",
            "address_2": "SUITE 606",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379161809",
            "telephone_number": "865-546-8040",
            "fax_number": "865-541-2787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 20TH ST",
            "address_2": "SUITE 606",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379161809",
            "telephone_number": "865-546-8040",
            "fax_number": "865-541-2787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CAVANAGH",
        "first_name": "KEVIN",
        "middle_name": "JAMES",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-12-01",
        "last_updated": "2011-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TN",
            "license": "124994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Knoxville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2011; 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.