Individual provider Active NPI

Sean Bradley Stacey, CRNA

  • Certified Registered Nurse Anesthetist
  • Saint Louis, MO
National Provider Identifier
1073076832
Registry record updated Jan 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
123790 Issued in MO
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

Updated by the provider on Jan 27, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
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

Enrollment IDStateProvider typePAC IDDetails
I20211012003065 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 1850624818 Reassigns benefits to 2 organizations

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
North American Partners in Anesthesia Illinois LLCGroup PAC ID 1052576519, 431 clinicians

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 Hospital, O Fallon, IL, CCN 140187

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
209023764ILMDCertified Registered Nurse Anesthetist
123790MOMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
North American Partners in Anesthesia (Illinois), LLC CurrentSince Sep 7, 2022 Accepting new patients
G & G Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2021 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.

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": "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.

Verify at the official NPI Registry.