NPIMap

Organization Active NPI

Anesthesia Associates of Southern Illinois Surgery Center LLC

  • Anesthesiology Physician
  • Mount Vernon, IL
National Provider Identifier
1043757487
Registry record updated Mar 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
ANESTHESIA ASSOCIATES OF SOUTHERN ILLINOIS SURGERY CENTER LLC
Practice address
2 Good Samaritan Way Ste 200
Mount Vernon, IL 62864-2476
Phone
(618) 899-5703
Fax
(618) 899-5704
NPI assigned
Jan 24, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 8, 2017

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

Authorized official

Name
Amanda Klopfenstein
Title
Financial Operations Manager
Phone
(314) 368-5849

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

2 Good Samaritan Way Ste 200
Mount Vernon, IL 62864-2476

Mailing address

2 Good Samaritan Way
Suite 205
Mount Vernon, IL 62864-2408
Phone (618) 899-3869

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170317000152 IL Part B Supplier - Clinic/Group Practice 0648555433 Receives reassigned benefits from 41 practitioners
Practice locations: Mount Vernon, IL

National Provider Directory

National Provider Directory

Locations

2 Good Samaritan Way
Ste 205
Mount Vernon, IL 62864
Phone (618) 241-1108

Practitioners & affiliated clinicians

Practitioners 42

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1485216000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488931200000",
    "number": "1043757487",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 GOOD SAMARITAN WAY",
            "address_2": "SUITE 205",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642408",
            "telephone_number": "618-899-3869",
            "fax_number": "618-899-3558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 GOOD SAMARITAN WAY STE 200",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642476",
            "telephone_number": "618-899-5703",
            "fax_number": "618-899-5704"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANESTHESIA ASSOCIATES OF SOUTHERN ILLINOIS SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-24",
        "last_updated": "2017-03-08",
        "status": "A",
        "authorized_official_last_name": "KLOPFENSTEIN",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "FINANCIAL OPERATIONS MANAGER",
        "authorized_official_telephone_number": "314-368-5849"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.