Eyasu Aduna
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · O Fallon, IL
NPI 1548062532 · NPPES record last updated Mar 27, 2025
Key facts
- NPI
- 1548062532
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 3 Saint Elizabeth Blvd Ste 4000
O Fallon, IL 62269-1284 - Phone
- (618) 233-5480
- Fax
- (844) 458-7916
- NPI assigned
- Mar 27, 2025
- Sex
- Unspecified or another gender identity
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250827002725 | MO | Order and Referring Only - Family Practice |
0749781227 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Interoperability endpoints
- eyasu.aduna.1@9559.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
3 Saint Elizabeth Blvd Ste 4000
O Fallon, IL 62269-1284
Mailing address
3 Saint Elizabeth Blvd Ste 4000
O Fallon, IL 62269-1284
Phone (618) 233-5480
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All providers in O Fallon, IL · Student in an Organized Health Care Education/Training Program in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 27, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.