NPIMap

Organization Active NPI

Midwest Anesthesia Providers S.C

  • Anesthesiology Physician
  • Saint Louis, MO
National Provider Identifier
1295189082
Registry record updated Feb 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
MIDWEST ANESTHESIA PROVIDERS S.C
Practice address
11133 Dunn Rd
Saint Louis, MO 63136-6163
Phone
(865) 293-5676
NPI assigned
Apr 18, 2016
Last updated
Feb 18, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2022

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

Authorized official

Name
Dr. Mark Gordon, MDNPI 1518915065
Title
President
Phone
(865) 293-5676

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 4

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X
Anesthesiologist AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 367H00000X

Addresses

Primary practice location

11133 Dunn Rd
Saint Louis, MO 63136-6163

Mailing address

1431 Centerpoint Blvd Ste 100
Knoxville, TN 37932-1983

Medicare participation

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

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20160628000182 IL Part B Supplier - Clinic/Group Practice 9830480581 Receives reassigned benefits from 251 practitioners
Practice locations: Alton, IL; Belleville, IL; Shiloh, IL
O20160712001846 MO Part B Supplier - Clinic/Group Practice 9830480581 Receives reassigned benefits from 221 practitioners
Practice locations: Farmington, MO; Saint Louis, MO; Saint Peters, MO; Sullivan, MO

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 428

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 428

NPI Registry JSON

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

{
    "created_epoch": "1460937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645142400000",
    "number": "1295189082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1431 CENTERPOINT BLVD STE 100",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379321983"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11133 DUNN RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366163",
            "telephone_number": "865-293-5676"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST ANESTHESIA PROVIDERS S.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-18",
        "last_updated": "2022-02-18",
        "certification_date": "2022-02-18",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "865-293-5676",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiologist Assistant",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2022; 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.