NPIMap

Organization Active NPI

Harbor Anesthesia PLLC

  • Anesthesiology Physician
  • Chicago, IL
National Provider Identifier
1205593290
Registry record updated Jun 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
HARBOR ANESTHESIA PLLC
Practice address
4226 N Kolmar Ave
Chicago, IL 60641-1900
Phone
(574) 253-1827
NPI assigned
Nov 24, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2024

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

Authorized official

Name
Noelle Wallin-Sanchez, CRNANPI 1194209718
Title
Coo
Phone
(574) 253-1827

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary

Addresses

Primary practice location

4226 N Kolmar Ave
Chicago, IL 60641-1900

Mailing address

P.O. Box 736317
Chicago, IL 60637-6317
Phone (574) 253-1827

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20220224001881 IL Part B Supplier - Clinic/Group Practice 4981098589 Receives reassigned benefits from 22 practitioners
Practice locations: Chicago, IL

National Provider Directory

National Provider Directory

Locations

47 W Division St
Ste 366
Chicago, IL 60610

Practitioners & affiliated clinicians

Practitioners 22

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1637712000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1717632000000",
    "number": "1205593290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 736317",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606376317",
            "telephone_number": "574-253-1827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4226 N KOLMAR AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606411900",
            "telephone_number": "574-253-1827"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARBOR ANESTHESIA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-24",
        "last_updated": "2024-06-06",
        "certification_date": "2024-05-30",
        "status": "A",
        "authorized_official_last_name": "WALLIN-SANCHEZ",
        "authorized_official_first_name": "NOELLE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "574-253-1827",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "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 Jun 6, 2024; 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.