Active NPI
Walter Laesch, C.R.N.A.
- Certified Registered Nurse Anesthetist
- Champaign, IL
National Provider Identifier
1639152952
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 209-000371
- Practice address
- 40 10 Riverknoll Dr
Champaign, IL 61822 - Phone
- (217) 356-5963
- Fax
- (217) 352-8947
- NPI assigned
- Nov 21, 2005
- Sex
- Male
- 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 | 209-000371 | IL | Primary |
Addresses
Primary practice location
40 10 Riverknoll Dr
Champaign, IL 61822
Mailing address
1016 W Union St
Champaign, IL 61821-3322
Phone (217) 359-2752
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09223524 | Other | IL | BC/BS GROUP ID NO. |
| 371390028001 | Other | IL | TRICARE GROUP ID NO. |
| 216564000 | Other | IL | WORKMAN'S COMP GROUP ID |
| CG3273 | Other | IL | RR MEDICARE GROUP ID NO. |
| 430052840 | Other | IL | RR MEDICARE GROUP ID NO. |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209-000371 | IL | MD | Certified Registered Nurse Anesthetist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1317772800000",
"number": "1639152952",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1016 W UNION ST",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618213322",
"telephone_number": "217-359-2752",
"fax_number": "217-359-8923"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "40 10 RIVERKNOLL DR",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "61822",
"telephone_number": "217-356-5963",
"fax_number": "217-352-8947"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LAESCH",
"first_name": "WALTER",
"name_prefix": "Mr.",
"credential": "C.R.N.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-21",
"last_updated": "2011-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "IL",
"license": "209-000371",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC/BS GROUP ID NO.",
"identifier": "09223524",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE GROUP ID NO.",
"identifier": "371390028001",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WORKMAN'S COMP GROUP ID",
"identifier": "216564000",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE GROUP ID NO.",
"identifier": "CG3273",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE GROUP ID NO.",
"identifier": "430052840",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.