Individual provider Active NPI

Paul D Hutsell, CRNA

  • Certified Registered Nurse Anesthetist
  • Peoria, IL
National Provider Identifier
1245377183
Registry record updated Apr 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209-014114 Issued in IL
Practice address
8600 State Route 91 Ste 250
Peoria, IL 61615-7831
Phone
(309) 692-5393
Fax
(309) 692-2538
NPI assigned
Jan 31, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2016

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 209-014114 IL Primary

Addresses

Primary practice location

8600 State Route 91 Ste 250
Peoria, IL 61615-7831

Mailing address

8600 State Route 91 Ste 250
Peoria, IL 61615-7831
Phone (309) 692-5393

Other identifiers 4

IdentifierTypeStateIssuer
125929701MedicaidAR
98333OtherARARK BLUE SHIELD
175118OtherMOMO BLUE SHIELD
912753506MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Anesthesiologists, S.C. CurrentSince Apr 11, 2016 Accepting new patients
Spectrum Health Inc Nurse Anesthetist, Certified Registered CurrentSince Dec 1, 2021 Accepting new patients
Associated Anesthesiologists, SC CurrentSince Dec 6, 2020 Accepting new patients
Principle Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2023 Accepting new patients
Umass Memorial Medical Group Inc Past Accepting new patients

Locations

430 Maxine Dr
Morton, IL 61550
Phone (309) 266-7600

8600 State Route 91
Ste 250
Peoria, IL 61615
Phone (309) 692-5393

4909 N Glen Park Place Rd
Peoria, IL 61614
Phone (309) 674-7546

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

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

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.

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": "1460419200000",
    "number": "1245377183",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 STATE ROUTE 91 STE 250",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616157831",
            "telephone_number": "309-692-5393",
            "fax_number": "309-692-2538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 STATE ROUTE 91 STE 250",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616157831",
            "telephone_number": "309-692-5393",
            "fax_number": "309-692-2538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HUTSELL",
        "first_name": "PAUL",
        "middle_name": "D",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-31",
        "last_updated": "2016-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209-014114",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "125929701",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARK BLUE SHIELD",
            "identifier": "98333",
            "state": "AR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MO BLUE SHIELD",
            "identifier": "175118",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "912753506",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.