Individual provider Active NPI

Bryon Sobczak, CRNA

  • Certified Registered Nurse Anesthetist
  • Fort Madison, IA
National Provider Identifier
1205973146
Registry record updated May 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
D-120718 Issued in IA
Practice address
5445 Avenue O
Fort Madison, IA 52627-9611
Phone
(319) 376-2047
Fax
(319) 376-2043
NPI assigned
Jan 31, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 18, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 209-004904 IL
Certified Registered Nurse Anesthetist 367500000X D-120718 IA Primary

Addresses

Primary practice location

5445 Avenue O
Fort Madison, IA 52627-9611

Mailing address

400 E 10TH St
Waconia, MN 55387-4552
Phone (952) 442-9770

Other practice location 1

3301 Broadway St
Quincy, IL 62301-3713
Phone (217) 277-4090

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040419001257 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 1658366588 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3301 Broadway St
Quincy, IL 62301-3713
Phone (217) 277-3500

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D-120718IAMDCertified Registered Nurse Anesthetist
209-004904ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Hospital Association CurrentSince Jan 1, 2022 Accepting new patients
Memorial Hospital Association CurrentSince Jan 1, 2022 Accepting new patients
St Luke'S Methodist Hospital Current Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Jul 1, 2021 Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Jul 1, 2021 Accepting new patients
Memorial Hospital Association Current Accepting new patients
Quincy Anesthesia Associates Past Accepting new patients

Locations

1454 N County Road 2050 E
Carthage, IL 62321
Phone (217) 357-3131

1005 Broadway St
Quincy, IL 62301

1025 Maine St
Quincy, IL 62301
Phone 21722265503163

3301 Broadway St
Quincy, IL 62301
Phone (217) 277-4070

Interoperability endpoints

  • Direct secure messaging: bsobczak802001@direct.unitypoint.org

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621296000000",
    "number": "1205973146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 10TH ST",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553874552",
            "telephone_number": "952-442-9770",
            "fax_number": "952-442-3630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5445 AVENUE O",
            "city": "FORT MADISON",
            "state": "IA",
            "postal_code": "526279611",
            "telephone_number": "319-376-2047",
            "fax_number": "319-376-2043"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3301 Broadway St",
            "address_purpose": "LOCATION",
            "city": "Quincy",
            "state": "IL",
            "postal_code": "623013713",
            "country_code": "US",
            "telephone_number": "217-277-4090",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SOBCZAK",
        "first_name": "BRYON",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2021-05-18",
        "certification_date": "2021-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209-004904",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IA",
            "license": "D-120718",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Madison, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 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.

Verify at the official NPI Registry.