Individual provider Active NPI

Mary M. Damery, CRNA

  • Certified Registered Nurse Anesthetist
  • Urbana, IL
National Provider Identifier
1528056504
Registry record updated Apr 12, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209005925 Issued in IL
Practice address
611 W Park St
Urbana, IL 61801-2529
Phone
(217) 383-3303
Fax
(217) 383-3265
NPI assigned
Oct 12, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2021

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 209005925 IL Primary

Addresses

Primary practice location

611 W Park St
Urbana, IL 61801-2529

Mailing address

611 W Park St
Fapc
Urbana, IL 61801

Other practice location 1

201 S 14th St
Herrin, IL 62948-3631
Phone (618) 942-2171

Other practice location 2

2 S Hospital Dr
Murphysboro, IL 62966-3333
Phone (618) 684-3156

Other practice location 3

405 W Jackson St
Carbondale, IL 62901-1462
Phone (618) 549-0721

Other identifiers 4

IdentifierTypeStateIssuer
209-005925OtherILIL APN LICENSE #
041298740OtherILIL LICENSE #
L031806OtherILCHAMPUS/TRICARE
0841504038OtherILBCBS OF ILLINOIS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051031000080 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 8628095593 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North American Partners in Anesthesia Illinois LLCGroup PAC ID 1052576519, 431 clinicians
Carlinville Area Hospital AssociationGroup PAC ID 9032021373, shared by 6 NPIs, 25 clinicians

Practice addresses (Care Compare)

1800 E Lake Shore Dr
Decatur, IL 62521-3810
Phone (217) 464-2966

20733 N Broad St
Carlinville, IL 62626-3710
Phone (217) 854-3141

Hospital & facility affiliations

  • St Marys Hospital Hospital, Decatur, IL, CCN 140166

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
209005925ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Medical Services, NFP CurrentSince Jun 3, 2020 Accepting new patients
Carlinville Area Hospital Association CurrentSince May 25, 2022 Accepting new patients
Carle Health Care Incorporated CurrentSince Nov 2, 2020 Accepting new patients
North American Partners in Anesthesia (Illinois), LLC CurrentSince Jan 1, 2024 Accepting new patients
Carlinville Area Hospital Association CurrentSince May 25, 2022 Accepting new patients
Carlinville Area Hospital Association CurrentSince Dec 13, 2025 Accepting new patients
Sangamon Associated Anesthesiologists, S.C. Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

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

405 W Jackson St
Carbondale, IL 62901

2601 W Main St
Carbondale, IL 62901
Phone (618) 351-7300

20733 N Broad St
Carlinville, IL 62626
Phone (217) 854-3141

1800 E Lake Shore Dr
Decatur, IL 62521
Phone (217) 464-2729

201 S 14th St
Herrin, IL 62948
Phone (618) 942-2171

2 S Hospital Dr
Murphysboro, IL 62966
Phone (618) 684-3156

800 E Carpenter St
Rm 2K
Springfield, IL 62769
Phone (217) 525-5643

800 E Carpenter St
Rm 2K64
Springfield, IL 62769
Phone (217) 525-5643

800 E Carpenter St
Rm 2334
Springfield, IL 62769
Phone (217) 525-5643

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

Interoperability endpoints

  • FHIR API: https://fhir-usa.unify.chbase.com/org/carlin-6115abf3

Organizations & group practices 8

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": "1129075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618185600000",
    "number": "1528056504",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "address_2": "FAPC",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "61801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012529",
            "telephone_number": "217-383-3303",
            "fax_number": "217-383-3265"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 S 14th St",
            "address_purpose": "LOCATION",
            "city": "Herrin",
            "state": "IL",
            "postal_code": "629483631",
            "country_code": "US",
            "telephone_number": "618-942-2171",
            "fax_number": "618-351-4919",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2 S Hospital Dr",
            "address_purpose": "LOCATION",
            "city": "Murphysboro",
            "state": "IL",
            "postal_code": "629663333",
            "country_code": "US",
            "telephone_number": "618-684-3156",
            "fax_number": "618-529-0529",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "405 W Jackson St",
            "address_purpose": "LOCATION",
            "city": "Carbondale",
            "state": "IL",
            "postal_code": "629011462",
            "country_code": "US",
            "telephone_number": "618-549-0721",
            "fax_number": "618-529-0449",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DAMERY",
        "first_name": "MARY",
        "middle_name": "M.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-12",
        "last_updated": "2021-04-12",
        "certification_date": "2021-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209005925",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL APN LICENSE #",
            "identifier": "209-005925",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL LICENSE #",
            "identifier": "041298740",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHAMPUS/TRICARE",
            "identifier": "L031806",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF ILLINOIS",
            "identifier": "0841504038",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbana, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 12, 2021; 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.