NPIMap

Organization Active NPI

Eye Anesthesia LLC

  • Anesthesiology Physician
  • Saint Louis, MO
National Provider Identifier
1528334182
Registry record updated Aug 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
EYE ANESTHESIA LLC
Practice address
12990 Manchester Rd
Suite 105
Saint Louis, MO 63131-1860
Phone
(314) 686-4200
Fax
(314) 686-4201
NPI assigned
Mar 28, 2012
Last updated
Aug 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 25, 2023

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

Authorized official

Name
Jennifer Lynn Killoren
Title
Administrator
Phone
(314) 686-4200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X NU Primary

Addresses

Primary practice location

12990 Manchester Rd
Suite 105
Saint Louis, MO 63131-1860

Mailing address

12990 Manchester Rd Ste 103
Saint Louis, MO 63131-1860
Phone (866) 226-9156

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20120828000886 MO Part B Supplier - Clinic/Group Practice 5698922581 Receives reassigned benefits from 65 practitioners
Practice locations: Saint Louis, MO
O20180820000106 IL Part B Supplier - Clinic/Group Practice 5698922581 Receives reassigned benefits from 16 practitioners
Practice locations: Maryville, IL; Swansea, IL

National Provider Directory

National Provider Directory

Locations

12990 Manchester Rd
Ste 105
Saint Louis, MO 63131
Phone (314) 686-4200

Practitioners & affiliated clinicians

Practitioners 79

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 79

NPI Registry JSON

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

{
    "created_epoch": "1332892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692921600000",
    "number": "1528334182",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12990 MANCHESTER RD STE 103",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631311860",
            "telephone_number": "866-226-9156"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12990 MANCHESTER RD",
            "address_2": "SUITE 105",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631311860",
            "telephone_number": "314-686-4200",
            "fax_number": "314-686-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EYE ANESTHESIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-28",
        "last_updated": "2023-08-25",
        "certification_date": "2023-08-25",
        "status": "A",
        "authorized_official_last_name": "KILLOREN",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "314-686-4200"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2023; 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.