Individual provider Active NPI

Jennifer Mary Petraitis, CRNA

  • Certified Registered Nurse Anesthetist
  • Joliet, IL
National Provider Identifier
1629372958
Registry record updated Dec 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
041.281965 Issued in IL
Practice address
1200 Maple Rd
Joliet, IL 60432-1439
Phone
(815) 740-1100
NPI assigned
Dec 30, 2010
Last updated
Dec 30, 2010By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 30, 2010

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 041.281965 IL Primary

Addresses

Primary practice location

1200 Maple Rd
Joliet, IL 60432-1439

Mailing address

255 W Michigan Ave
PO Box 1123
Jackson, MI 49201-2218
Phone (517) 787-6440

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110308000943 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 4385826627 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allied Anesthesia Associates P CGroup PAC ID 0042118069, 53 clinicians

Practice addresses (Care Compare)

1900 Silver Cross Blvd
New Lenox, IL 60451-9509
Phone (815) 300-1100

403 S Kennedy Dr
Bradley, IL 60915-2152
Phone (815) 928-9999

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
041.281965ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Allied Anesthesia Associates, P.C. CurrentSince Dec 13, 2010 Accepting new patients

Locations

403 S Kennedy Dr
Bradley, IL 60915
Phone (815) 928-9999

185 Penny Ave
East Dundee, IL 60118
Phone (847) 836-7015

1200 Maple Rd
Joliet, IL 60432
Phone (815) 740-1100

1301 Copperfield Ave
Joliet, IL 60432
Phone (815) 726-6611

10719 160th St
Orland Park, IL 60467
Phone (702) 263-3300

Organizations & group practices 1

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 2

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": "1293667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1293667200000",
    "number": "1629372958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "255 W MICHIGAN AVE",
            "address_2": "PO BOX 1123",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "492012218",
            "telephone_number": "517-787-6440",
            "fax_number": "517-787-4146"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 MAPLE RD",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604321439",
            "telephone_number": "815-740-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRAITIS",
        "first_name": "JENNIFER",
        "middle_name": "MARY",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-30",
        "last_updated": "2010-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "041.281965",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2010; 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.