Individual provider Active NPI

Greg Mendrek, CRNA

  • Certified Registered Nurse Anesthetist
  • Moline, IL
National Provider Identifier
1144227406
Registry record updated Apr 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Practice address
545 Valley View Dr
Moline, IL 61265-6138
Phone
(309) 762-5560
Fax
(309) 762-7351
NPI assigned
Jul 1, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2008

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 IL Primary

Addresses

Primary practice location

545 Valley View Dr
Moline, IL 61265-6138

Mailing address

545 Valley View Dr
Moline, IL 61265-6138
Phone (309) 762-5560

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050218000123 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 5395797203 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

3333 N Seminary St
Galesburg, IL 61401-1251
Phone (309) 344-3161

Hospital & facility affiliations

  • Osf Saint Luke Medical Center Hospital, Kewanee, IL, CCN 141325
  • St Mary Medical Center Hospital, Galesburg, IL, CCN 140064
  • Osf Holy Family Medical Center Hospital, Monmouth, IL, CCN 141318

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209001416ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Osf Healthcare System Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Sep 1, 2021 Accepting new patients
Central PA Pharmacy LLC. Current Accepting new patients
St Mary Medical Center Past Accepting new patients

Locations

695 N Kellogg St
Galesburg, IL 61401
Phone (309) 343-8131

3333 N Seminary St
Galesburg, IL 61401
Phone (309) 344-3161

1051 W South St
Kewanee, IL 61443
Phone (309) 734-3141

1000 W Harlem Ave
Monmouth, IL 61462
Phone (309) 734-1414

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

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.

Hospital & facility affiliations 3

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": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208649600000",
    "number": "1144227406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 VALLEY VIEW DR",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656138",
            "telephone_number": "309-762-5560",
            "fax_number": "309-762-7351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 VALLEY VIEW DR",
            "city": "MOLINE",
            "state": "IL",
            "postal_code": "612656138",
            "telephone_number": "309-762-5560",
            "fax_number": "309-762-7351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENDREK",
        "first_name": "GREG",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-01",
        "last_updated": "2008-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moline, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2008; 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.