Active NPI
Mary M. Damery, CRNA
- Certified Registered Nurse Anesthetist
- Urbana, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 209005925
- 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
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 209-005925 | Other | IL | IL APN LICENSE # |
| 041298740 | Other | IL | IL LICENSE # |
| L031806 | Other | IL | CHAMPUS/TRICARE |
| 0841504038 | Other | IL | BCBS OF ILLINOIS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
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
- Carlinville Area Hospital Association
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
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209005925 | IL | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Southern Illinois Medical Services, NFP | Current | Accepting new patients | |
| Carlinville Area Hospital Association | Current | Accepting new patients | |
| Carle Health Care Incorporated | Current | Accepting new patients | |
| North American Partners in Anesthesia (Illinois), LLC | Current | Accepting new patients | |
| Carlinville Area Hospital Association | Current | Accepting new patients | |
| Carlinville Area Hospital Association | Current | 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
- 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.
-
- Anesthesiology Physician
- Oak Park, IL
- NPI 1699032524
-
- Internal Medicine Physician
- Urbana, IL
- NPI 1154653947
-
- Critical Access Hospital
- Carlinville, IL
- NPI 1053425124
-
- Critical Access Hospital
- Carlinville, IL
- NPI 1932275641
-
- Internal Medicine Physician
- Carbondale, IL
- NPI 1770656837
-
- Critical Access Hospital
- Rushville, IL
- NPI 1013969112
-
- Rural Health Clinic/Center
- Virden, IL
- NPI 1447691571
-
- Certified Registered Nurse Anesthetist
- Springfield, IL
- NPI 1699712661
Nurse Anesthetist, Certified Registered
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Decatur, IL
- NPI 1326041229
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.