Active NPI
Keith A. Marino, CRNA
- Certified Registered Nurse Anesthetist
- Chicago, IL
National Provider Identifier
1104841451
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 209-003972
- Practice address
- 1901 W Harrison St
Chicago, IL 60612-3714 - Phone
- (312) 400-2978
- NPI assigned
- Jul 13, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 209-003972 | IL | Primary |
Addresses
Primary practice location
1901 W Harrison St
Chicago, IL 60612-3714
Mailing address
1272 Drover Dr
Lemont, IL 60439-7348
Phone (708) 299-9858
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104841451 | Medicaid | IL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kmarino@direct.ccprovider.org | Direct | Cook County |
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, 2001
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1901 W Harrison St
Chicago, IL 60612-3714
Phone (312) 633-7292
500 E 51St St
Chicago, IL 60615-2494
Phone (312) 572-2000
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 95.11 of 100
- Quality
- 74.7
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 85.45
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209-003972 | IL | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cook County | Current | Accepting new patients | |
| Cook County | Current | Accepting new patients | |
| Cook County | Current | Accepting new patients |
Locations
1901 W Harrison St
Chicago, IL 60612
Phone (312) 864-5100
1969 W Ogden Ave
Chicago, IL 60612
Phone (312) 864-3600
1900 W Polk St
Rm G16
Chicago, IL 60612
500 E 51st St
Chicago, IL 60615
Phone (312) 572-2000
Interoperability endpoints
- kmarino@direct.ccprovider.org
Organizations & group practices 3
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.
-
- General Acute Care Hospital
- Chicago, IL
- NPI 1588612832
-
- Emergency Medicine Physician
- Chicago, IL
- NPI 1821385170
-
- Multi-Specialty Clinic/Center
- Chicago, IL
- NPI 1831219450
Hospital & facility affiliations 27
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": "1152748800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619481600000",
"number": "1104841451",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1272 DROVER DR",
"city": "LEMONT",
"state": "IL",
"postal_code": "604397348",
"telephone_number": "708-299-9858"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1901 W HARRISON ST",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606123714",
"telephone_number": "312-400-2978"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARINO",
"first_name": "KEITH",
"middle_name": "A.",
"name_prefix": "Mr.",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-13",
"last_updated": "2021-04-27",
"certification_date": "2021-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "IL",
"license": "209-003972",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1104841451",
"state": "IL"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kmarino@direct.ccprovider.org",
"affiliation": "Y",
"affiliationName": "Cook County",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1969 W. Ogden Ave.",
"city": "Chicago",
"state": "IL",
"country_code": "US",
"postal_code": "606123723",
"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 Apr 27, 2021; 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.