Individual provider Active NPI

Evangelos G. Tambassis, M.D.

  • Anesthesiology Physician
  • Jefferson City, MO
National Provider Identifier
1679569198
Registry record updated Apr 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
104008 Issued in MO
Practice address
1445 Christy Dr
Jefferson City, MO 65101-2853
Phone
(573) 636-3483
Fax
(573) 636-5315
NPI assigned
Sep 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 5, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 104008 MO Primary
Anesthesiology Physician 207L00000X 036.117610 IL

Addresses

Primary practice location

1445 Christy Dr
Jefferson City, MO 65101-2853

Mailing address

1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099
Phone (217) 234-2120

Other practice location 1

1 Saint Elizabeth Blvd
O Fallon, IL 62269-1099
Phone (618) 234-2120

Other practice location 2

1005 Broadway St
Quincy, IL 62301-2834
Phone (217) 223-8400

Other identifiers 1

IdentifierTypeStateIssuer
203941224MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070514000081 IL Practitioner - Anesthesiology 4587761325 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Blessing HospitalGroup PAC ID 3072422534, 414 clinicians
Midwest Anesthesia Providers SCGroup PAC ID 9830480581, 180 clinicians

Practice addresses (Care Compare)

1005 Broadway St
Quincy, IL 62301-2834
Phone (217) 223-8400

4500 Memorial Dr
Belleville, IL 62226-5360
Phone (618) 233-7750

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036.117610ILMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Blessing Hospital CurrentSince Apr 15, 2022 Accepting new patients
North American Partners in Anesthesia (Illinois), LLC Anesthesiology CurrentSince May 1, 2022 Accepting new patients
Midwest Anesthesia Providers S.C Anesthesiology CurrentSince Mar 17, 2023 Accepting new patients
Blessing Hospital Anesthesiology CurrentSince Apr 15, 2022 Accepting new patients
Mid-Missouri Anesthesia Consultants PC Anesthesiology PastSince Jul 1, 1996 Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

1 Saint Elizabeth Blvd
O Fallon, IL 62269
Phone 618234212012438

1005 Broadway St
Quincy, IL 62301

1404 Cross St
Shiloh, IL 62269
Phone (618) 607-1000

4500 Memorial Dr
Swansea, IL 62226
Phone (618) 233-7750

1305 Walt Whitman Rd
Ste 300
Melville, NY 11747
Phone (516) 370-3796

Interoperability endpoints

  • FHIR API: https://fhir.blessinghospital.com/R4/open-Prod

Organizations & group practices 5

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

Hospital & facility affiliations 3

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": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1649116800000",
    "number": "1679569198",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 SAINT ELIZABETH BLVD",
            "city": "O FALLON",
            "state": "IL",
            "postal_code": "622691099",
            "telephone_number": "217-234-2120"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1445 CHRISTY DR",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651012853",
            "telephone_number": "573-636-3483",
            "fax_number": "573-636-5315"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Saint Elizabeth Blvd",
            "address_purpose": "LOCATION",
            "city": "O Fallon",
            "state": "IL",
            "postal_code": "622691099",
            "country_code": "US",
            "telephone_number": "618-234-2120",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1005 Broadway St",
            "address_purpose": "LOCATION",
            "city": "Quincy",
            "state": "IL",
            "postal_code": "623012834",
            "country_code": "US",
            "telephone_number": "217-223-8400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TAMBASSIS",
        "first_name": "EVANGELOS",
        "middle_name": "G.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-20",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MO",
            "license": "104008",
            "primary": true
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036.117610",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "203941224",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Jefferson City, MO

Sources for this page

Verify at the official NPI Registry.