Avery Smith, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

209027680 Issued in IL

Practice address

1101 W Pratt Blvd Apt 2W
Chicago, IL 60626-4477

Phone

(312) 953-0564

NPI assigned

Sep 23, 2021

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• Amalie Smith Former name

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Illinois Gastroenterology Group, LLC

  • Gastroenterology Physician
  • Elgin, IL
  • NPI 1316277817
  Medicare reassignment NPD
• North American Partners in Anesthesia (Illinois), LLC

  • Anesthesiology Physician
  • Oak Park, IL
  • NPI 1699032524
  Medicare reassignment NPD
• 360 Anesthesia PLLC

  • Anesthesiology Physician
  • Wilkes Barre, PA
  • NPI 1811637366

  IL, Nurse Anesthetist, Certified Registered

  Medicare reassignment NPD
• Elgin Gastroenterology Endoscopy Center LLC

  dba The Endo Center of Elgin Gastroenterology

  • Ambulatory Surgical Clinic/Center
  • Elgin, IL
  • NPI 1992875454
  NPD
• Elgin Gastroenterology SC

  • Gastroenterology Physician
  • Elgin, IL
  • NPI 1932291101
  NPD
• Northwest Gastroenterologists SC

  • Specialist
  • Arlington Heights, IL
  • NPI 1801886221
  NPD

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

{
    "created_epoch": "1632355200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686873600000",
    "number": "1124799655",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 W PRATT BLVD APT 2W",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606264477",
            "telephone_number": "312-953-0564"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 W PRATT BLVD APT 2W",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606264477",
            "telephone_number": "312-953-0564"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH",
        "first_name": "AVERY",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-09-23",
        "last_updated": "2023-06-16",
        "certification_date": "2023-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041400420",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "WI",
            "license": "25878830",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209027680",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMALIE",
            "last_name": "SMITH",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Artise Smith
• Ashley Corinne Smith, LCPC
• Ashley L Smith, PHARMD, MA,EDS
• Ashley Renee Smith, PT, DPT
• Autumn Elizabeth Smith, MS, CCC-SLP
• Barbara Hudson Smith, LCSW
• Ben Carlton Smith, MD
• Betty B. Smith, LCSW, BCD
• Billye Raye Smith, RN
• Blair Smith

• Certified Registered Nurse Anesthetist in Chicago, IL
• Providers in Chicago, IL by specialty
• Certified Registered Nurse Anesthetist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.