Active NPI
Kenneth R Showman, CRNA
- Certified Registered Nurse Anesthetist
- Johnson City, TN
National Provider Identifier
1962495804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- RN0000048049
- Practice address
- 1009 Lark St
Suite 2
Johnson City, TN 37604-8217 - Phone
- (423) 283-0776
- Fax
- (423) 283-0549
- NPI assigned
- Aug 25, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | RN0000048049 | TN | Primary |
Addresses
Primary practice location
1009 Lark St
Suite 2
Johnson City, TN 37604-8217
Mailing address
PO Box 3727
Johnson City, TN 37602-3727
Phone (423) 283-0776
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3606199 | Medicaid | TN |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23039 | TN | MD | Pediatric Nurse Practitioner |
| RN0000048049 | TN | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Anesthesia and Pain Consultants,P.C. | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
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.
-
- Anesthesiology Physician
- Johnson City, TN
- NPI 1750399127
Nurse Anesthetist, Certified Registered
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1124928000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1400112000000",
"number": "1962495804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3727",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376023727",
"telephone_number": "423-283-0776",
"fax_number": "423-283-0549"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1009 LARK ST",
"address_2": "SUITE 2",
"city": "JOHNSON CITY",
"state": "TN",
"postal_code": "376048217",
"telephone_number": "423-283-0776",
"fax_number": "423-283-0549"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHOWMAN",
"first_name": "KENNETH",
"middle_name": "R",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-08-25",
"last_updated": "2014-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "TN",
"license": "RN0000048049",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3606199",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Johnson City, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.