NPIMap

Organization Active NPI

G & G Anesthesia LLC

  • Certified Registered Nurse Anesthetist
  • Maryville, IL
National Provider Identifier
1487020111
Registry record updated Feb 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209007445 Issued in IL
Legal business name
G & G ANESTHESIA LLC
Practice address
2023 Vadalabene Dr Ste 350
Maryville, IL 62062-5637
Phone
(618) 205-8302
NPI assigned
Aug 17, 2015
Last updated
Feb 27, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 27, 2026

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

Authorized official

Name
Randy Pruetzel
Title
Manager
Phone
(618) 205-8304

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X 209007445 IL Primary

Addresses

Primary practice location

2023 Vadalabene Dr Ste 350
Maryville, IL 62062-5637

Mailing address

2023 Vadalabene Dr Ste 350
Maryville, IL 62062-5637
Phone (618) 205-8302

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, NM, MO3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
O20150930000831 IL Part B Supplier - Clinic/Group Practice 4981912607 Receives reassigned benefits from 143 practitioners
Practice locations: Marion, IL; Red Bud, IL; Mount Vernon, IL; Maryville, IL; Herrin, IL; Granite City, IL; Glen Carbon, IL; Edwardsville, IL…
O20191220000506 NM Part B Supplier - Clinic/Group Practice 4981912607 Receives reassigned benefits from 15 practitioners
Practice locations: Deming, NM
O20210204002043 MO Part B Supplier - Clinic/Group Practice 4981912607 Receives reassigned benefits from 10 practitioners
Practice locations: Cape Girardeau, MO; Weldon Spring, MO

National Provider Directory

National Provider Directory

Locations

510 Lincoln Dr
Herrin, IL 62948
Phone (618) 997-3100

2023 Vadalabene Dr
Ste 350
Maryville, IL 62062
Phone (618) 205-8302

Practitioners & affiliated clinicians

Practitioners 178

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 178

NPI Registry JSON

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

{
    "created_epoch": "1439769600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772150400000",
    "number": "1487020111",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2023 VADALABENE DR STE 350",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625637",
            "telephone_number": "618-205-8302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2023 VADALABENE DR STE 350",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625637",
            "telephone_number": "618-205-8302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G & G ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-17",
        "last_updated": "2026-02-27",
        "certification_date": "2026-02-27",
        "status": "A",
        "authorized_official_last_name": "PRUETZEL",
        "authorized_official_first_name": "RANDY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "618-205-8304"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209007445",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2026; 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.