Active NPI
Obinna Charles Iluba, CRNA
- Certified Registered Nurse Anesthetist
- Dyer, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 139085
- Practice address
- 24 Joliet St
Dyer, IN 46311-1705 - Phone
- (917) 922-9498
- NPI assigned
- Jun 19, 2022
- 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 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 28228006A | IN | |
| Certified Registered Nurse Anesthetist | 367500000X | RN328399 | GA | |
| Certified Registered Nurse Anesthetist | 367500000X | 139085 | IN | Primary |
Addresses
Primary practice location
24 Joliet St
Dyer, IN 46311-1705
Mailing address
24 Joliet St
Dyer, IN 46311-1705
Other practice location 1
1000 Medical Center Blvd
Lawrenceville, GA 30046-7694
Phone (678) 312-1000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN, GA
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1000 Medical Ctr Blvd
Lawrenceville, GA 30046-7694
Phone (678) 312-1000
301 Philip Blvd
Suite B
Lawrenceville, GA 30046-8746
Phone (770) 822-5560
Hospital & facility affiliations
- Northside Hospital Gwinnett
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28228006A | IN | MD | Registered Nurse |
| 139085 | IN | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northstar Anesthesia of Indiana LLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Sentry Anesthesia Management, LLC | Current | Accepting new patients | |
| North Atlanta Anesthesia Professionals, LLC | Current | Accepting new patients | |
| Bindal Anesthesiologists, LTD | Past | Accepting new patients |
Locations
13500 Powers Ct
Ste 230
Fort Myers, FL 33912
Phone (239) 610-0784
1000 Medical Center Blvd
Lawrenceville, GA 30046
Phone (678) 312-3356
1000 Johnson Ferry Rd
Sandy Springs, GA 30342
Phone (404) 851-8737
24 Joliet St
Dyer, IN 46311
Phone (219) 864-2237
Organizations & group practices 6
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.
-
- Anesthesiology Physician
- Atlanta, GA
- NPI 1982349296
-
- Certified Registered Nurse Anesthetist
- Gainesville, GA
- NPI 1326569187
-
- Anesthesiology Physician
- Arlington, TX
- NPI 1043561541
IN, Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Newnan, GA
- NPI 1134544794
-
- Anesthesiology Physician
- Savannah, GA
- NPI 1750753786
-
- Anesthesiology Physician
- Merrillville, IN
- NPI 1538115407
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Lawrenceville, GA
- NPI 1952340994
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1655596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1716163200000",
"number": "1194456400",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "24 JOLIET ST",
"city": "DYER",
"state": "IN",
"postal_code": "463111705"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "24 JOLIET ST",
"city": "DYER",
"state": "IN",
"postal_code": "463111705",
"telephone_number": "917-922-9498"
}
],
"practiceLocations": [
{
"address_1": "1000 Medical Center Blvd",
"address_purpose": "LOCATION",
"city": "Lawrenceville",
"state": "GA",
"postal_code": "300467694",
"country_code": "US",
"telephone_number": "678-312-1000",
"fax_number": "678-312-3282",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "ILUBA",
"first_name": "OBINNA",
"middle_name": "CHARLES",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-19",
"last_updated": "2024-05-20",
"certification_date": "2024-05-20",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "IN",
"license": "28228006A",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "GA",
"license": "RN328399",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "IN",
"license": "139085",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Dyer, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; 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.