Individual provider Active NPI

Kristopher Wayne Rauchle, CRNA

  • Certified Registered Nurse Anesthetist
  • Joplin, MO
National Provider Identifier
1972096733
Registry record updated Jul 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
117738 Issued in MO
Practice address
1531 E 32ND St Ste 6
Joplin, MO 64804-2970
Phone
(417) 553-0210
NPI assigned
Jun 7, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2024

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 2011011036 MO
Certified Registered Nurse Anesthetist 367500000X 117738 MO Primary

Addresses

Primary practice location

1531 E 32ND St Ste 6
Joplin, MO 64804-2970

Mailing address

1671 Foxboro CT
Bentonville, AR 72713-9369
Phone (816) 520-3326

Other practice location 1

1101 Jackson St SW
Gravette, AR 72736-9121
Phone (417) 787-5291

Other names 1

  • N/a N/a N/a Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210331000831 AR Practitioner - Certified Registered Nurse Anesthetist (Crna) 9739436452 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sgoh Acquisition IncGroup PAC ID 5092616276, 95 clinicians

Practice addresses (Care Compare)

1101 Jackson St SW
Gravette, AR 72736-9121
Phone (479) 787-5291

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2011011036MOMDRegistered Nurse
117738MOMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Gastro Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2021 Accepting new patients
Sgoh Acquisition Inc CurrentSince May 15, 2024 Accepting new patients
Sgoh Acquisition Inc CurrentSince May 15, 2024 Accepting new patients

Locations

3700 SE Dodson Rd
Ste 4
Bentonville, AR 72712
Phone (479) 308-4300

3344 N Futrall Dr
Ste 3
Fayetteville, AR 72703
Phone (479) 582-7280

3344 N Futrall Dr
Fayetteville, AR 72703
Phone (479) 582-7213

1101 Jackson St SW
Gravette, AR 72736
Phone (479) 787-5221

405 N University Ave
Little Rock, AR 72205
Phone (501) 228-4445

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1528329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1720569600000",
    "number": "1972096733",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1671 FOXBORO CT",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727139369",
            "telephone_number": "816-520-3326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1531 E 32ND ST STE 6",
            "city": "JOPLIN",
            "state": "MO",
            "postal_code": "648042970",
            "telephone_number": "417-553-0210"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1101 Jackson St SW",
            "address_purpose": "LOCATION",
            "city": "Gravette",
            "state": "AR",
            "postal_code": "727369121",
            "country_code": "US",
            "telephone_number": "417-787-5291",
            "fax_number": "417-344-6404",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RAUCHLE",
        "first_name": "KRISTOPHER",
        "middle_name": "WAYNE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-06-07",
        "last_updated": "2024-07-10",
        "certification_date": "2024-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2011011036",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "117738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "N/A",
            "last_name": "N/A",
            "middle_name": "N/A",
            "credential": "DNAP, CRNA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Joplin, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2024; 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.