Individual provider Active NPI

Thomas P Nolan, CRNA

  • Certified Registered Nurse Anesthetist
  • Gibson, IL
National Provider Identifier
1477592137
Registry record updated Oct 25, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
28124135A Issued in IN
Practice address
1120 N Melvin St
Gibson, IL 60936
Phone
(217) 784-4251
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 25, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 28124135A IN Primary
Certified Registered Nurse Anesthetist 367500000X 209.001102 IL

Addresses

Primary practice location

1120 N Melvin St
Gibson, IL 60936

Mailing address

20940 Bradford Dr
Mokena, IL 60448-1470
Phone (708) 341-1369

Other practice location 1

20940 Bradford Dr
Mokena, IL 60448-1470
Phone (815) 469-1187

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040624000605 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 6608852413 Reassigns benefits to 5 organizations
I20060724000044 IN Practitioner - Certified Registered Nurse Anesthetist (Crna) 6608852413 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gibson Community Hospital Association 159 clinicians
Anesthesia Dynamics LLC 883 clinicians
Redreef Anesthesia Associates Chartered Indiana LLC 36 clinicians

Practice addresses (Care Compare)

1120 N Melvin St
Gibson City, IL 60936-1477
Phone (217) 784-4251

4411 Washington Ave
Suite 100
Evansville, IN 47714-0805
Phone (313) 637-9861

600 Grant St
Gary, IN 46402-6001
Phone (888) 851-4642

Hospital & facility affiliations

  • Methodist Hospitals Inc Hospital, Gary, IN, CCN 150002
  • Gibson Community Hospital Hospital, Gibson City, IL, CCN 141317

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209.001102ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Gibson Community Hospital Association CurrentSince Feb 1, 2021 Accepting new patients
Redreef Anesthesia Associates Chartered Indiana LLC CurrentSince Aug 9, 2024 Accepting new patients
Gibson Community Hospital Association CurrentSince Feb 1, 2021 Accepting new patients
Gibson Community Hospital Association Current Accepting new patients
Ucm Medical Group Sub, LLC CurrentSince Nov 15, 2021 Accepting new patients
North American Partners in Anesthesia (Illinois), LLC CurrentSince Dec 1, 2023 Accepting new patients
Anesthesia Dynamics LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 10, 2024 Accepting new patients
Illinois Anesthesia Associates PC Nurse Anesthetist, Certified Registered Past Accepting new patients
American Anesthesiology of Illinois, LLC Past Accepting new patients
Windy City Anesthesia PC Nurse Anesthetist, Certified Registered Past Accepting new patients
Windy City Anesthesia PC Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

12935 Gregory St
Blue Island, IL 60406
Phone (708) 597-2000

27702 Network Pl
Chicago, IL 60673

77 N Airlite St
Elgin, IL 60123
Phone (847) 622-3407

2800 W 95th St
Evergreen Pk, IL 60805
Phone (708) 229-5104

7 Doctors Park
Gibson City, IL 60936
Phone (217) 784-5500

1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684

1 Ingalls Dr
Harvey, IL 60426
Phone (708) 333-2300

998 N 129th Infantry Dr
Joliet, IL 60435
Phone (815) 744-3000

455 W Court St
Ste 300
Kankakee, IL 60901
Phone (815) 939-2033

350 N Wall St
Kankakee, IL 60901
Phone (815) 935-7500

1000 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-2389

20201 Crawford Ave
Olympia Flds, IL 60461
Phone (708) 503-3857

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

11051 Broadway
Ste B
Crown Point, IN 46307
Phone (219) 308-0193

4411 Washington Ave
Ste 100
Evansville, IN 47714
Phone (313) 637-9861

1500 S Lake Park Ave
Hobart, IN 46342
Phone (219) 942-0551

8701 Broadway
Merrillville, IN 46410
Phone (219) 738-4926

Interoperability endpoints

  • Direct secure messaging: tnolan224585@uchospital.direct-ci.com

Organizations & group practices 26

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.

View all 26

Hospital & facility affiliations 24

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 24

NPI Registry JSON

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

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729814400000",
    "number": "1477592137",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20940 BRADFORD DR",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604481470",
            "telephone_number": "708-341-1369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1120 N MELVIN ST",
            "city": "GIBSON",
            "state": "IL",
            "postal_code": "60936",
            "telephone_number": "217-784-4251"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20940 Bradford Dr",
            "address_purpose": "LOCATION",
            "city": "Mokena",
            "state": "IL",
            "postal_code": "604481470",
            "country_code": "US",
            "telephone_number": "815-469-1187",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOLAN",
        "first_name": "THOMAS",
        "middle_name": "P",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2024-10-25",
        "certification_date": "2024-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IN",
            "license": "28124135A",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209.001102",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 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.