KENNETH K POTTS (NPI# 1316960404) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1316960404 |
| Entity Type | Individual |
| Full Name | KENNETH K POTTS |
| Credential | C.R.N.A. |
| Practice Address |
1401 East 12th Street Mendota IL 61342-9216 |
| Practice Telephone | 8155397461 |
| Practice Fax Number | 8155391461 |
| Mailing Telephone | 8155397461 |
| Mailing Fax Number | 8155391461 |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2011-12-30 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | 041136641 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043384514 | Kenneth C Potts | Psychiatry & Neurology | 1153 Centre St, Jamaica Plain, MA 02130-3446 | 2006-11-17 |
| 1225120884 | Kenneth Charles Potts | Counselor | 1819 Bay Scott Cir Ste 109, Naperville, IL 60540-1130 | 2006-09-29 |
| Street Address |
1401 EAST 12TH STREET |
| City | MENDOTA |
| State | IL |
| Zip Code | 61342-9216 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609803113 | Mendota Community Hospital | General Acute Care Hospital | 1401 East 12th Street, Mendota, IL 61342-9216 | 2006-06-28 |
| 1376673087 | Mendota Community Hospital | Prosthetic/Orthotic Supplier | 1401 East 12th Street, Mendota, IL 61342-9216 | 2007-03-06 |
| 1962537498 | Mendota Community Hospital | General Acute Care Hospital | 1401 East 12th Street, Mendota, IL 61342-9216 | 2007-02-23 |
| 1912009887 | James F Meyer | Nurse Anesthetist, Certified Registered | 1401 East 12th Street, Mendota, IL 61342-9216 | 2006-09-02 |
| 1114931276 | Kenneth J. Beggs | Nurse Anesthetist, Certified Registered | 1401 East 12th Street, Mendota, IL 61342-9216 | 2006-07-27 |
| 1417973900 | Mendota Community Hospital | Emergency Medicine | 1401 East 12th Street, Mendota, IL 61342-9216 | 2006-07-15 |
| 1407872997 | Mendota Community Hospital | Orthopaedic Surgery | 1401 East 12th Street, Mendota, IL 61342-9216 | 2006-07-15 |
| 1922024843 | Mendota Community Hospital | Medicare Defined Swing Bed Unit | 1401 East 12th Street, Mendota, IL 61342-9216 | 2006-07-14 |
| 1952336323 | Mendota Community Hospital | Nurse Anesthetist, Certified Registered | 1401 East 12th Street, Mendota, IL 61342-9216 | 2006-07-12 |
| 1578598751 | Mendota Community Hospital | Prosthetic/Orthotic Supplier | 1401 East 12th Street, Mendota, IL 61342-9216 | 2006-07-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568536845 | Keri Sundberg | Dentist | 709 Plaza Drive, Mendota, IL 61342 | 2006-11-20 |
| 1114022589 | Goslin Drug Store Inc | Pharmacy | 1212 13th Ave, Mendota, IL 61342 | 2006-09-13 |
| 1467402412 | Neungja Chung | Acupuncturist | Mendota Community Hospital, 1315 Memorial Drive, Mendota, IL 61342 | 2006-05-11 |
| 1487622205 | Kelly R. Minihane | Physician Assistant | 1404 Washington Street, Mendota, IL 61342 | 2006-03-08 |
| 1134193022 | Donald Wilbert Piller | Chiropractor | 1312 Lakewood Dr, Mendota, IL 61342 | 2006-02-15 |
| 1770975377 | National Pain Clinic, LLC | Anesthesiology | 1401 E 12th St, Mendota, IL 61342 | 2015-02-19 |
| 1073869475 | Katherine Rose Riva-foster | Anesthesiology | 1401 E 12th St, Mendota, IL 61342 | 2012-08-03 |
| 1386789220 | Juli Renee Barrett Leifheit | Chiropractor | 901 Main St, Ste A, Mendota, IL 61342 | 2007-02-20 |
| 1205383197 | Mendota Community Hospital | Clinic/Center | 1401 Washington Street, Mendota, IL 61342-0001 | 2016-09-08 |
| 1780699447 | Linnea L Person | Chiropractor | 1301 14th Ave, Mendota, IL 61342-1001 | 2006-07-30 |
| Find all providers in zip 61342 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376879122 | Richard Jospeh Baker | Nurse Anesthetist, Certified Registered | 1401 E 12th St, Mendota, IL 61342-9216 | 2009-10-29 |
| 1912009887 | James F Meyer | Nurse Anesthetist, Certified Registered | 1401 East 12th Street, Mendota, IL 61342-9216 | 2006-09-02 |
| 1114931276 | Kenneth J. Beggs | Nurse Anesthetist, Certified Registered | 1401 East 12th Street, Mendota, IL 61342-9216 | 2006-07-27 |
| 1952336323 | Mendota Community Hospital | Nurse Anesthetist, Certified Registered | 1401 East 12th Street, Mendota, IL 61342-9216 | 2006-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639797525 | Crna Stat Inc | Nurse Anesthetist, Certified Registered | 4534 S Lake Park Ave, Chicago, IL 60653-4510 | 2020-07-08 |
| 1285258855 | Doug Brickey | Nurse Anesthetist, Certified Registered | 913 N Main St Apt 502, Rockford, IL 61103-7058 | 2020-05-30 |
| 1508480153 | Scott Allsup | Nurse Anesthetist, Certified Registered | 1337 W Early Ave Apt 1, Chicago, IL 60660-5465 | 2020-05-29 |
| 1265051817 | Apollo Anesthesia and Pain Management, Pllc | Nurse Anesthetist, Certified Registered | 520 Valley View Dr Ste 300, Moline, IL 61265-6152 | 2020-04-14 |
| 1194352286 | Decelle Jewel Manuel Enriquez | Nurse Anesthetist, Certified Registered | 251 E Huron St Ste F5-704, Chicago, IL 60611-2908 | 2020-03-26 |
| 1538795398 | Marcin Cebula | Nurse Anesthetist, Certified Registered | 7519 Long Ave, Burbank, IL 60459-1362 | 2020-03-12 |
| 1376105684 | Tel Anesthesia, Ltd | Nurse Anesthetist, Certified Registered | 7 Flint Ct, Bloomington, IL 61705-8830 | 2019-07-08 |
| 1013474071 | Vitalz Anesthesia Unlimited LLC | Nurse Anesthetist, Certified Registered | 6708 N Knoxville Ave Ste 1, Peoria, IL 61614-2863 | 2019-02-26 |
| 1689130247 | Sheri Rylko | Nurse Anesthetist, Certified Registered | 1653 W. Congress Pkwy. Jelke 7, Chicago, IL 60612 | 2019-02-19 |
| 1760968101 | Daniel Bermea | Nurse Anesthetist, Certified Registered | 6811 Brementowne Dr, Tinley Park, IL 60477-1605 | 2018-07-18 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.