Active NPI
Sean Bradley Stacey, CRNA
- Certified Registered Nurse Anesthetist
- Saint Louis, MO
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 123790
- Practice address
- 6420 Clayton Rd
Saint Louis, MO 63117-1811 - Phone
- (314) 768-8442
- NPI assigned
- Apr 9, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 209023764 | IL | |
| Certified Registered Nurse Anesthetist | 367500000X | 123790 | MO | Primary |
Addresses
Primary practice location
6420 Clayton Rd
Saint Louis, MO 63117-1811
Mailing address
775A Chamberlain PL
Webster Groves, MO 63119-2707
Phone (618) 218-7267
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2019
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099
Phone (618) 234-2120
3249 Oak Park Ave
Berwyn, IL 60402-3429
Phone (708) 783-9100
Hospital & facility affiliations
- HSHS St Elizabeth'S Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209023764 | IL | MD | Certified Registered Nurse Anesthetist |
| 123790 | MO | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| North American Partners in Anesthesia (Illinois), LLC | Current | Accepting new patients | |
| G & G Anesthesia LLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
Locations
1 Saint Anthonys Way
Alton, IL 62002
Phone (618) 233-6870
3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696
2100 Madison Ave
Granite City, IL 62040
Phone (618) 798-3000
1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438
1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796
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.
-
- Anesthesiology Physician
- Oak Park, IL
- NPI 1699032524
-
- Certified Registered Nurse Anesthetist
- Maryville, IL
- NPI 1487020111
Nurse Anesthetist, Certified Registered
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- O Fallon, IL
- NPI 1629057302
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554768000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674777600000",
"number": "1073076832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "775A CHAMBERLAIN PL",
"city": "WEBSTER GROVES",
"state": "MO",
"postal_code": "631192707",
"telephone_number": "618-218-7267"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6420 CLAYTON RD",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631171811",
"telephone_number": "314-768-8442"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STACEY",
"first_name": "SEAN",
"middle_name": "BRADLEY",
"name_prefix": "Mr.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-09",
"last_updated": "2023-01-27",
"certification_date": "2023-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "IL",
"license": "209023764",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MO",
"license": "123790",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Saint Louis, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2023; 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.