NPIMap

Organization Active NPI

Mobile Anesthesiologists of Missouri, LLC

  • Anesthesiology Physician
  • Chicago, IL
National Provider Identifier
1053699736
Registry record updated Jul 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
2011012170 Issued in MO
Legal business name
MOBILE ANESTHESIOLOGISTS OF MISSOURI, LLC
Practice address
8420 W Bryn Mawr Ave
Suite 300
Chicago, IL 60631-3479
Phone
(773) 355-5300
Fax
(773) 714-1353
NPI assigned
Jul 28, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 28, 2011

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

Authorized official

Name
Dr. Robert S Gerson, MD
Title
President & Ceo
Phone
(480) 276-2667

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X 2011012170 MO Primary

Addresses

Primary practice location

8420 W Bryn Mawr Ave
Suite 300
Chicago, IL 60631-3479

Mailing address

8420 W Bryn Mawr Ave
Suite 300
Chicago, IL 60631-3479
Phone (773) 355-5300

Other identifiers 1

IdentifierTypeStateIssuer
726903MedicaidAZ

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1311811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1311811200000",
    "number": "1053699736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8420 W BRYN MAWR AVE",
            "address_2": "SUITE 300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313479",
            "telephone_number": "773-355-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8420 W BRYN MAWR AVE",
            "address_2": "SUITE 300",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606313479",
            "telephone_number": "773-355-5300",
            "fax_number": "773-714-1353"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE ANESTHESIOLOGISTS OF MISSOURI, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-28",
        "last_updated": "2011-07-28",
        "status": "A",
        "authorized_official_last_name": "GERSON",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "480-276-2667",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "2011012170",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "726903",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.