St. Mary'S Hospital, Centralia, Illinois
Organization Active NPI Anesthesiology Physician · Centralia, IL
NPI 1477097871 · NPPES record last updated Mar 26, 2018
Key facts
- NPI
- 1477097871
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Anesthesiology Physician 207L00000X
- License
- 0002642 (IL)
- Legal business name
- ST. MARY'S HOSPITAL, CENTRALIA, ILLINOIS
- Practice address
- 400 N Pleasant Ave
Centralia, IL 62801-3056 - Phone
- (618) 436-6056
- Fax
- (618) 532-9365
- NPI assigned
- Dec 5, 2016
- Organization subpart
- No
Authorized official
- Name
- Mr. Tim Buller, CFO
- Title
- Regional Cfo
- Phone
- (314) 989-2492
Other NPIs on the same Medicare enrollment 1
Practitioners 152
-
Tushar Advani, MD, PHD
-
Mark David Alter, M.D.
-
Loring Barr, APRN
-
Dianne L Beyer, CRNA
-
Christopher Bourget, CRNA
-
Jeremy S Bowen, P.A.
-
Greg A Brooks, CRNA
-
Michael Charles Burke, M.D.
-
Erbert Caceres, MD
-
Patricia Isabel Calcetto, CRNA
-
Ismat Cheema, DO
-
Jason Chon, M.D.
-
Jamie Josephine Compton, CRNA
-
Vincent Coty Compton, CRNA
-
Kathy Sue Devous, AGACNP-BC
-
Mameyan Donzo, MD
-
Elizabeth Eggemeyer, CRNA
-
Jamie Lorraine Evans, M.D., M.P.H.
-
Treniece Nichole Finney, AGACNP
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040127000118 | IL | Part B Supplier - Clinic/Group Practice | 6709788920 |
Receives reassigned benefits from 395 practitioners 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Centralia, IL |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician |
207L00000X | 0002642 | IL | Yes |
| Pain Medicine (Anesthesiology) Physician |
207LP2900X | 0002642 | IL |
Addresses
Primary practice location
400 N Pleasant Ave
Centralia, IL 62801-3056
Mailing address
1145 Corporate Lake Dr
Saint Louis, MO 63132-2907
Phone (314) 989-2492
Other names
- SSM Health St. Mary's Hospital - Centralia
Other providers in Centralia, IL
- Sara Michelle Spencer
- Laura Spenner
- Dale H Spitler
- St Mary'S Hospital, Centralia, Illinois
- St. Mary'S Hospital, Centralia, Illinois
- St. Mary'S Hospital, Centralia, Illinois
- St. Mary'S Hospital, Centralia, Illinois
- St. Mary'S Hospital, Centralia, Illinois
- St. Marys Good Samaritan Inc
- Katelyn Starr
All providers in Centralia, IL · Anesthesiology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 26, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.