Individual provider Active NPI

Kenneth R Showman, CRNA

  • Certified Registered Nurse Anesthetist
  • Johnson City, TN
National Provider Identifier
1962495804
Registry record updated May 15, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN0000048049 Issued in TN
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

Updated by the provider on May 15, 2014

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 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

IdentifierTypeStateIssuer
3606199MedicaidTN

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

LicenseStateTypeSpecialty
23039TNMDPediatric Nurse Practitioner
RN0000048049TNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia and Pain Consultants,P.C. Nurse Anesthetist, Certified Registered PastSince Mar 1, 2000 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.

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.

Verify at the official NPI Registry.