Individual provider Active NPI

Adekunle Adesuyi, CRNA

  • Certified Registered Nurse Anesthetist
  • Chicago, IL
National Provider Identifier
1073757803
Registry record updated Feb 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN582611 Issued in PA
Practice address
5645 W Addison St
Chicago, IL 60634-2881
Phone
(773) 282-7000
NPI assigned
Apr 23, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN582611 PA Primary

Addresses

Primary practice location

5645 W Addison St
Chicago, IL 60634-2881

Mailing address

1412 W Division St Apt 3
Chicago, IL 60642-3323
Phone (847) 858-5276

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Chicago

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101228000602 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 8527119775 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Anesthesiologists SCGroup PAC ID 6305744129, 150 clinicians

Practice addresses (Care Compare)

6742 N Frostwood Pkwy
Peoria, IL 61615-2402
Phone (309) 692-5393

Hospital & facility affiliations

  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Anesthesiologists, SC CurrentSince Mar 21, 2022 Accepting new patients
Associated Anesthesiologists, S.C. CurrentSince Mar 21, 2022 Accepting new patients
Town Square Anesthesia LLC CurrentSince Jul 15, 2017 Accepting new patients
Huntley Anesthesia Associates LLC CurrentSince Apr 26, 2018 Accepting new patients

Locations

5645 W Addison St
Chicago, IL 60634
Phone (773) 282-7000

10350 Haligus Rd
Huntley, IL 60142
Phone (847) 802-7150

6742 N Frostwood Pkwy
Peoria, IL 61615
Phone (309) 692-5393

530neglen Oak Ave
Peoria, IL 61637
Phone (309) 692-5393

3703 Doty Rd
Woodstock, IL 60098
Phone (815) 334-3170

Organizations & group practices 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1240444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644796800000",
    "number": "1073757803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1412 W DIVISION ST APT 3",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606423323",
            "telephone_number": "847-858-5276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5645 W ADDISON ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606342881",
            "telephone_number": "773-282-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADESUYI",
        "first_name": "ADEKUNLE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-23",
        "last_updated": "2022-02-14",
        "certification_date": "2022-02-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "PA",
            "license": "RN582611",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Chicago",
            "affiliation": "N",
            "address_1": "5645 W Addison St",
            "city": "Chicago",
            "state": "IL",
            "country_code": "US",
            "postal_code": "606342881",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "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 Feb 14, 2022; 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.