NPIMap

Organization Active NPI

Anesthesia of Southern Illinois LLC

  • Certified Registered Nurse Anesthetist
  • Belleville, IL
National Provider Identifier
1053662932
Registry record updated Oct 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
ANESTHESIA OF SOUTHERN ILLINOIS LLC
Practice address
2810 Frank Scott Pkwy W Ste 716
Belleville, IL 62223-5007
Phone
(618) 355-0880
Fax
(618) 355-0881
NPI assigned
Oct 2, 2012
Last updated
Oct 3, 2012By the provider in NPPES
Organization subpart
Yes
Parent organization
VASANTHA PAI, MD PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 3, 2012

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

Authorized official

Name
Dr. Sudha Pai, MD
Title
Administrator
Phone
(618) 698-4021

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

2810 Frank Scott Pkwy W Ste 716
Belleville, IL 62223-5007

Mailing address

2810 Frank Scott Pkwy W Ste 716
Belleville, IL 62223-5007
Phone (618) 355-0880

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130131000501 IL Part B Supplier - Clinic/Group Practice 4183878044 Receives reassigned benefits from 11 practitioners
Practice locations: Belleville, IL

National Provider Directory

National Provider Directory
Part of
Vasantha Pai MD PC

Locations

2810 Frank Scott Pkwy W
Ste 716
Belleville, IL 62223
Phone (618) 355-0880

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1349136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349222400000",
    "number": "1053662932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2810 FRANK SCOTT PKWY W STE 716",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622235007",
            "telephone_number": "618-355-0880",
            "fax_number": "618-355-0881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2810 FRANK SCOTT PKWY W STE 716",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "622235007",
            "telephone_number": "618-355-0880",
            "fax_number": "618-355-0881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANESTHESIA OF SOUTHERN ILLINOIS LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VASANTHA PAI, MD PC",
        "enumeration_date": "2012-10-02",
        "last_updated": "2012-10-03",
        "status": "A",
        "authorized_official_last_name": "PAI",
        "authorized_official_first_name": "SUDHA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "618-698-4021",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2012; 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.