MR. ROGER O KENNEDY (CRNA) – Certified Registered Nurse Anesthetist, NPI 1659484848
Certified Registered Nurse Anesthetist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
716 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in AR
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Provider Addresses for MR. ROGER O KENNEDY (CRNA)
PO BOX 738
CLARKSVILLE, AR 728300738
Phone: (479) 754-5454
Fax: (479) 754-5311
Type: Mailing
Johnson Regional Medical Center, 1100, East Poplar Street, Clarksville, Johnson County, Arkansas, 72830, United States
CLARKSVILLE, AR 728304419
Phone: (479) 754-5454
Fax: (479) 754-5311
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-12-29
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20101229000270 | I | Certified Registered Nurse Anesthetist (Crna) | AR | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 72830)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| CERTIFIED REGISTERED NURSE ANESTHET | AR | 00142 | Anesthesia for lens surgery | 21 | 21 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Certified Registered Nurse Anesthetist (Crna) | AR | |
| - | LA | |
| Certified Registered Nurse Anesthetist (Crna) | TX | |
| Certified Registered Nurse Anesthetist (Crna) | AR | |
| General Surgery | AR | |
| Nurse Practitioner | AR | |
| O B S T E T R I C S/ G Y N E C O L O G Y | AR | |
| - | AR | |
| Orthopedic Surgery | AR | |
| Certified Registered Nurse Anesthetist (Crna) | AR |
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