Individual provider Active NPI

Mia P. Zeller, APN-CRNA

  • Certified Registered Nurse Anesthetist
  • Evanston, IL
National Provider Identifier
1003535543
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209030111 Issued in IL
Practice address
2650 Ride Ave.
Department of Anesthesia
Evanston, IL 60201-1718
Phone
(847) 570-2760
Fax
(847) 570-2921
NPI assigned
Aug 26, 2022
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163W00000X 041.466864 IL
Certified Registered Nurse Anesthetist 367500000X 209030111 IL Primary

Addresses

Primary practice location

2650 Ride Ave.
Department of Anesthesia
Evanston, IL 60201-1718

Mailing address

2650 Ride Ave.
Department of Anesthesia
Evanston, IL 60201-1718
Phone (847) 570-2760

Other practice location 1

5145 N. California Ave.
Department of Anesthesia
Chicago, IL 60625-3661
Phone (773) 293-5486

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240809001787 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 3870031776 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Endeavor Health Medical GroupGroup PAC ID 2163334699, 3,330 clinicians

Practice addresses (Care Compare)

2100 Pfingsten Rd
Glenview, IL 60026-1301

2650 Ridge Ave
Evanston, IL 60201-1700

9600 Gross Point Rd
Skokie, IL 60076-1214

Hospital & facility affiliations

  • Northshore University Healthsystem - Evanston Hospital Hospital, Evanston, IL, CCN 140010

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041.466864ILMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Endeavor Health Medical Group Single Specialty CurrentSince Jul 25, 2024 Accepting new patients
Endeavor Health Medical Group Single Specialty Current Accepting new patients

Locations

5145 N California Ave
Chicago, IL 60625
Phone (773) 989-3800

9532 Eagle Way
Chicago, IL 60678

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2650 Ridge Ave
Evanston, IL 60201
Phone (847) 570-1206

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

Organizations & group practices 2

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1661472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1003535543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2650 RIDE AVE.",
            "address_2": "DEPARTMENT OF ANESTHESIA",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2760",
            "fax_number": "847-570-2921"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2650 RIDE AVE.",
            "address_2": "DEPARTMENT OF ANESTHESIA",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602011718",
            "telephone_number": "847-570-2760",
            "fax_number": "847-570-2921"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5145 N. California Ave.",
            "address_2": "Department of Anesthesia",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606253661",
            "country_code": "US",
            "telephone_number": "773-293-5486",
            "fax_number": "773-989-1639",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ZELLER",
        "first_name": "MIA",
        "middle_name": "P.",
        "credential": "APN-CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-26",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.466864",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209030111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Evanston, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 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.