Individual provider Active NPI

Sunyang Lee, CRNA

  • Certified Registered Nurse Anesthetist
  • Peoria, IL
National Provider Identifier
1336829431
Registry record updated Sep 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209030033 Issued in IL
Practice address
6742 N Frostwood Pkwy
Peoria, IL 61615-2402
Phone
(309) 692-5393
Fax
(309) 683-9998
NPI assigned
Jul 24, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 6, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 2016006196 MO
Certified Registered Nurse Anesthetist 367500000X 209030033 IL Primary

Addresses

Primary practice location

6742 N Frostwood Pkwy
Peoria, IL 61615-2402

Mailing address

661 Harding Rd Apt 210C
Morton, IL 61550-0515
Phone (417) 379-6991

Other practice location 1

661 Harding Rd Apt 201C
Morton, IL 61550-0515
Phone (417) 379-6991

Other names 1

  • Sunyang Park Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240822002623 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 2769921733 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Anesthesiologists SCGroup PAC ID 6305744129, 150 clinicians

Practice addresses (Care Compare)

6742 N Frostwood Pkwy
Peoria, IL 61615-2402
Phone (309) 692-5393

Hospital & facility affiliations

  • Saint Francis Medical Center Hospital, Peoria, IL, CCN 140067

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2016006196MOMDGeneral Practice Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Anesthesiologists, S.C. CurrentSince Jul 25, 2024 Accepting new patients
Associated Anesthesiologists, SC CurrentSince Jul 25, 2024 Accepting new patients

Locations

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

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

Organizations & group practices 2

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": "1690156800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725580800000",
    "number": "1336829431",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "661 HARDING RD APT 210C",
            "city": "MORTON",
            "state": "IL",
            "postal_code": "615500515",
            "telephone_number": "417-379-6991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6742 N FROSTWOOD PKWY",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616152402",
            "telephone_number": "309-692-5393",
            "fax_number": "309-683-9998"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "661 Harding Rd Apt 201C",
            "address_purpose": "LOCATION",
            "city": "Morton",
            "state": "IL",
            "postal_code": "615500515",
            "country_code": "US",
            "telephone_number": "417-379-6991",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LEE",
        "first_name": "SUNYANG",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-24",
        "last_updated": "2024-09-06",
        "certification_date": "2024-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "MO",
            "license": "2016006196",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209030033",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUNYANG",
            "last_name": "PARK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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 Sep 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.
  • 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.