MR. CHANNON LAWRENCE MCKIBBEN
NPI 1487189429
Nurse Anesthetist, Certified Registered in Marengo, IA

Q: What is Channon Mckibben's NPI number?

The NPI number for Channon Mckibben is 1487189429. It was assigned to this individual provider in the NPPES registry on April 27, 2017.

Q: What is Channon Mckibben's specialty?

The primary specialty registered for this NPI is Nurse Anesthetist, Certified Registered with taxonomy code 367500000X.

Q: When was this NPI record last updated?

The NPPES record for Channon Mckibben was last updated on July 9, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since April 27, 2017PECOS EnrolledAccepts Medicare Assignment

300 W MAY ST, MARENGO, IA 52301(319) 642-5543 Get Directions Write a Review

NPPES record last updated: July 9, 2019. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Jul 9, 2019, Apr 27, 2017 (2 updates tracked since 2017).

On this page

About Mr. Channon Lawrence Mckibben NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. CHANNON LAWRENCE MCKIBBEN (NPI 1487189429) is an individual nurse anesthetist, certified registered in Marengo, Iowa, licensed in Iowa (117476) and active in the NPI registry since April 2017. He is enrolled in Medicare PECOS, is affiliated with Compass Memorial Healthcare, and is a graduate of Other (2019).

NPPES Registry Identity

NPI1487189429

Entity TypeIndividualMale

Primary Taxonomy367500000X

Provider Legal NameMR. CHANNON LAWRENCE MCKIBBEN

Location Address300 W MAY STMarengo, IA 52301-1261

Mailing Address300 W May StMarengo, IA 52301-1261 · (319) 642-5543

Phone(319) 642-5543

Sole ProprietorYes

Medical School CMSOtherGraduated 2019

Enumeration DateApril 27, 2017

Last NPPES UpdateJuly 9, 20192 updates tracked since enumeration

✔ NPI 1487189429 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code367500000X

License✔ Licensed in IA · 117476

Definition

(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.

300 W MAY ST, Marengo, IA 52301

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Other Identifiers 1

Other117476IA · Rn License

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Wellmark Health Plan of Iowa, Inc..Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Channon Lawrence Mckibben is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6608208467

PECOS Enrollment IDI20191115001499

Eligible to Order & Refer✔ Part B Labs & Imaging– Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Channon Mckibben reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Marengo Memorial Hospital

Same address

Critical Access

300 W MAY ST
Marengo, IA 52301

Reassigned Medicare billing, Iowa enrollment
Also billed through NPI 1053368191 (Iowa)
75 clinicians in this Medicare group

NPI 1356402929 (319) 642-5543

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Compass Memorial Healthcare

Critical Access Hospitals · Marengo, IA

OwnershipGovernment - Local

CMS Certification Number161317

Location300 W May StMarengo, IA 52301 · Iowa County

Emergency services

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 52301 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$122.23 typical visit price

range $52.96 – $161.40

Typical copayment $30.55 (range $13.24 – $40.35)

Most-billed visit code 99204

Established Patient

$66.36 typical visit price

range $16.91 – $131.98

Typical copayment $16.59 (range $4.22 – $32.99)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MARENGO MEMORIAL HOSPITAL

General Acute Care Hospital (Critical Access)