NPIMap

Organization Active NPI

Elite Anesthesia Providers, LTD

  • Anesthesiology Physician
  • Mokena, IL
National Provider Identifier
1679258388
Registry record updated Jun 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
ELITE ANESTHESIA PROVIDERS, LTD
Practice address
19110 Darvin Dr Ste a
Mokena, IL 60448-8683
Phone
(708) 478-8889
Fax
(708) 478-8507
NPI assigned
Jun 20, 2023
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 20, 2023

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

Authorized official

Name
Mark Tomczak, CRNANPI 1235188533
Title
President
Phone
(708) 431-0160

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

19110 Darvin Dr Ste a
Mokena, IL 60448-8683

Mailing address

PO Box 70
Lake Forest, IL 60045-0070
Phone (800) 444-6110

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, IN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230905001966 IL Part B Supplier - Clinic/Group Practice 6709249006 Receives reassigned benefits from 58 practitioners
Practice locations: Mokena, IL; Naperville, IL; New Lenox, IL
O20240110000479 IN Part B Supplier - Clinic/Group Practice 6709249006 Receives reassigned benefits from 29 practitioners
Practice locations: Fremont, IN; Crown Point, IN; Schererville, IN; Munster, IN; Highland, IN

National Provider Directory

National Provider Directory

Locations

2211 Main St
Ste 1A
Highland, IN 46322
Phone (219) 836-2201

Practitioners & affiliated clinicians

Practitioners 72

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 72

NPI Registry JSON

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

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687219200000",
    "number": "1679258388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 70",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600450070",
            "telephone_number": "800-444-6110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19110 DARVIN DR STE A",
            "city": "MOKENA",
            "state": "IL",
            "postal_code": "604488683",
            "telephone_number": "708-478-8889",
            "fax_number": "708-478-8507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE ANESTHESIA PROVIDERS, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-20",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A",
        "authorized_official_last_name": "TOMCZAK",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-431-0160",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mokena, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.