NPIMap

Individual provider Active NPI

Courtney J Harris, CRNA

  • Certified Registered Nurse Anesthetist
  • O'Fallon, IL
National Provider Identifier
1235764218
Registry record updated Apr 17, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209.020870 Issued in IL
Practice address
1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099
Phone
(618) 234-2120
Fax
(618) 641-5810
NPI assigned
Mar 10, 2020
Last updated
Apr 17, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 17, 2020

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 209.020870 IL Primary

Addresses

Primary practice location

1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099

Mailing address

319 N Oakcrest Ave
Decatur, IL 62522-1812
Phone (314) 616-5191

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20200521000760 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 3375974652 Reassigns benefits to 2 organizations
I20220318001363 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 3375974652 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, shared by 26 NPIs, 1,121 clinicians
Mid-America Anesthesia Consultants PCGroup PAC ID 6305837626, 49 clinicians

Practice addresses (Care Compare)

1235 E Cherokee St
Springfield, MO 65804-2203
Phone (417) 820-2600

1600 E Broadway
Columbia, MO 65201-5844
Phone (573) 815-5511

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
67.07 of 100Reported as apm
Quality
85.4
Promoting interoperability
0
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.020870ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Anesthesiologists, SC CurrentSince Nov 7, 2022 Accepting new patients
Saint Francis Medical Center CurrentSince Nov 20, 2022 Accepting new patients
Mid-America Anesthesia Consultants, PC CurrentSince Oct 1, 2024 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jan 24, 2026 Accepting new patients
Midwest Anesthesia Providers S.C Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2022 Accepting new patients
Saint Francis Medical Center Nurse Anesthetist, Certified Registered Current Accepting new patients
Associated Anesthesiologists, S.C. CurrentSince Nov 7, 2022 Accepting new patients
Northstar Anesthesia of Illinois, LLC Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2025 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jan 24, 2026 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Jan 24, 2026 Accepting new patients
Saint Francis Medical Center CurrentSince Nov 20, 2022 Accepting new patients

Locations

530neglen Oak Ave
Peoria, IL 61637
Phone (309) 692-5393

6742 N Frostwood Pkwy
Peoria, IL 61615
Phone (309) 692-5393

1423 Chicago Rd
Sauk Village, IL 60411
Phone (708) 679-2160

1600 E Broadway
Columbia, MO 65201
Phone (573) 632-5000

211 Saint Francis Dr
Cpe Girardeau, MO 63703
Phone (573) 331-3000

11133 Dunn Rd
Saint Louis, MO 63136
Phone (314) 653-5000

10 Hospital Dr
Saint Peters, MO 63376
Phone (636) 394-2522

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1583798400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1235764218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "319 N OAKCREST AVE",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625221812",
            "telephone_number": "314-616-5191"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 SAINT ELIZABETH BLVD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691099",
            "telephone_number": "618-234-2120",
            "fax_number": "618-641-5810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARRIS",
        "first_name": "COURTNEY",
        "middle_name": "J",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-03-10",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209.020870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in O'Fallon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; 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.