Kelly Bacon, is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Idabel, Oklahoma. He graduated from nursing school in 2003 and has 21 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). He is a member of the group practice Western Oklahoma Anesthesia Consultants Pllc, Sc Anesthesia Llc and his current practice location is
1301 E Lincoln Rd, Idabel, Oklahoma. You can reach out to his office (for appointments etc.) via phone at
(580) 286-7623.
Kelly Bacon is licensed to practice in Oklahoma (license number R0071221) and he also participates in the medicare program. He
accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1700844313.
Provider's Profile
| Full Name | Kelly Bacon |
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| Gender | Male |
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| Speciality | Certified Registered Nurse Anesthetist (crna) |
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| Experience | 21 Years |
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| Location | 1301 E Lincoln Rd, Idabel, Oklahoma |
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| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Kelly Bacon graduated from nursing school in 2003
NPI Data:
- NPI Number: 1700844313
- Provider Enumeration Date: 05/03/2006
- Last Update Date: 10/26/2021
Medicare PECOS Information:
- PECOS PAC ID: 6103710470
- Enrollment ID: I20211101001542
Medical Identifiers
Medical identifiers for Kelly Bacon such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1700844313 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 367H00000X | Anesthesiologist Assistant | R0071221 (Oklahoma) | Secondary |
| 367500000X | Nurse Anesthetist, Certified Registered | R0071221 (Oklahoma) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Western Oklahoma Anesthesia Consultants Pllc | 4587924865 | 31 |
| Sc Anesthesia Llc | 7012382468 | 5 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Kelly Bacon allows following entities to bill medicare on his behalf.
| Entity Name | St. Anthony Shawnee Hospital, Inc. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1619260411
PECOS PAC ID: 1052567328
Enrollment ID: O20121015000218 |
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| Entity Name | Sc Anesthesia Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1962106013
PECOS PAC ID: 7012382468
Enrollment ID: O20230818001535 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Kelly Bacon is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Kelly Bacon,
Po Box 1547,
Sedalia, MO 65302-1547
Ph: (660) 826-5960 | Kelly Bacon,
1301 E Lincoln Rd,
Idabel, OK 74745-7300
Ph: (580) 286-7623 |
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