Individual provider Active NPI

Kathryn Mentzer, CRNA

  • Certified Registered Nurse Anesthetist
  • Decatur, IL
National Provider Identifier
1487079596
Registry record updated May 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209011205 Issued in IL
Practice address
2300 N Edward St
Decatur, IL 62526-4163
Phone
(217) 876-8121
Fax
(217) 876-2287
NPI assigned
Feb 26, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 14, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 209011205 IL Primary

Addresses

Primary practice location

2300 N Edward St
Decatur, IL 62526-4163

Mailing address

2300 N Edward St
Decatur, IL 62526-4163
Phone (217) 876-8121

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140514000118 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 9537382858 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Decatur Memorial HospitalGroup PAC ID 6204731144, 173 clinicians

Practice addresses (Care Compare)

2300 N Edward St
Decatur, IL 62526-4163
Phone (217) 876-8121

Hospital & facility affiliations

  • Decatur Memorial Hospital Hospital, Decatur, IL, CCN 140135

Merit-based Incentive Payment System (MIPS)

Final score
73.88 of 100Reported as group
Quality
63.91
Improvement activities
40
Cost
77.03

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
209011205ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Decatur Memorial Hospital Nurse Anesthetist, Certified Registered CurrentSince Feb 26, 2014 Accepting new patients
Taylorville Memorial Hospital Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2024 Accepting new patients
Decatur Memorial Hospital CurrentSince Feb 26, 2014 Accepting new patients
Taylorville Memorial Hospital CurrentSince Jan 1, 2024 Accepting new patients

Locations

2300 N Edward St
Decatur, IL 62526
Phone (217) 876-3000

241 W Weaver Rd
Ste 145B
Forsyth, IL 62535
Phone (217) 876-5220

201 E Pleasant St
Taylorville, IL 62568
Phone (217) 707-5555

Organizations & group practices 5

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.

Hospital & facility affiliations 1

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

NPI Registry JSON

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

{
    "created_epoch": "1393372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1400025600000",
    "number": "1487079596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 N EDWARD ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264163",
            "telephone_number": "217-876-8121",
            "fax_number": "217-876-2287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 N EDWARD ST",
            "city": "DECATUR",
            "state": "IL",
            "postal_code": "625264163",
            "telephone_number": "217-876-8121",
            "fax_number": "217-876-2287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MENTZER",
        "first_name": "KATHRYN",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-02-26",
        "last_updated": "2014-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209011205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2014; 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.