NPIMap

Individual provider Active NPI

Michael Patrick Henry Perkins, CRNA

  • Certified Registered Nurse Anesthetist
  • Mount Vernon, IL
National Provider Identifier
1619546447
Registry record updated Jul 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209023463 Issued in IL
Practice address
2 Good Samaritan Way Ste 205
Mount Vernon, IL 62864-2476
Phone
(618) 899-3869
Fax
(618) 899-3558
NPI assigned
Jun 24, 2021
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 041.473827 IL
Certified Registered Nurse Anesthetist 367500000X 209023463 IL Primary

Addresses

Primary practice location

2 Good Samaritan Way Ste 205
Mount Vernon, IL 62864-2476

Mailing address

2 Good Samaritan Way Ste 205
Mount Vernon, IL 62864-2476
Phone (618) 899-3869

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210812000312 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 7012311020 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1120 N Melvin St
Gibson City, IL 60936-1477
Phone (217) 784-4251

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041.473827ILMDRegistered Nurse
209023463ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Gibson Community Hospital Association CurrentSince Sep 28, 2022 Accepting new patients
St. Mary's Hospital, Centralia, Illinois CurrentSince Jul 1, 2021 Accepting new patients
St. Mary's Hospital, Centralia, Illinois CurrentSince Jul 1, 2021 Accepting new patients
Marion Anesthesia Company LLC Nurse Anesthetist, Certified Registered CurrentSince Apr 27, 2022 Accepting new patients
Gibson Community Hospital Association CurrentSince Sep 28, 2022 Accepting new patients
Anesthesia Associates of Southern Illinois Surgery Center LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 23, 2021 Accepting new patients

Locations

400 N Pleasant Ave
Centralia, IL 62801
Phone (618) 436-5221

7420 Solutions Ctr
Chicago, IL 60677
Phone (314) 989-3155

7 Doctors Park
Gibson City, IL 60936
Phone (217) 784-5500

1120 N Melvin St
Gibson City, IL 60936
Phone (217) 355-1684

3003 Civic Circle Blvd
Marion, IL 62959
Phone (618) 993-1112

4225 Lincolnshire Dr
Ste B
Mount Vernon, IL 62864

2 Good Samaritan Way
Ste 205
Mount Vernon, IL 62864
Phone (618) 241-1108

2 Good Samaritan Way
Ste 200
Mount Vernon, IL 62864
Phone (618) 899-3869

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1624492800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626912000000",
    "number": "1619546447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 GOOD SAMARITAN WAY STE 205",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642476",
            "telephone_number": "618-899-3869",
            "fax_number": "618-899-3558"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 GOOD SAMARITAN WAY STE 205",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628642476",
            "telephone_number": "618-899-3869",
            "fax_number": "618-899-3558"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERKINS",
        "first_name": "MICHAEL",
        "middle_name": "PATRICK HENRY",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-06-24",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041.473827",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209023463",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 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.