Individual provider Active NPI

Steven W Etcheson, CRNA

  • Certified Registered Nurse Anesthetist
  • Urbana, IL
National Provider Identifier
1679799241
Registry record updated Jun 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209001440 Issued in IL
Practice address
602 W. University Avenue
Anesthesiology
Urbana, IL 61801
Phone
(217) 383-3141
Fax
(217) 383-3265
NPI assigned
Apr 18, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 5, 2012

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 209001440 IL Primary

Addresses

Primary practice location

602 W. University Avenue
Anesthesiology
Urbana, IL 61801

Mailing address

P.O. Box 6002
Urbana, IL 61803-6002
Phone (217) 326-8300

Other identifiers 1

IdentifierTypeStateIssuer
6447860011MedicaidIL

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

Practice roles

OrganizationSpecialtyStatusNew patients
Hoopeston Community Memorial Hospital CurrentSince Jan 1, 2014 Accepting new patients
Carle Health Care Incorporated CurrentSince Apr 1, 2010 Accepting new patients
Hoopeston Community Memorial Hospital CurrentSince Jan 1, 2014 Accepting new patients
Hoopeston Community Memorial Hospital Past Accepting new patients
Premier Anesthesia of Urbana Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

701 E Orange St
Hoopeston, IL 60942
Phone (217) 283-5531

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

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.

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1338854400000",
    "number": "1679799241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 6002",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618036002",
            "telephone_number": "217-326-8300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "602 W. UNIVERSITY AVENUE",
            "address_2": "ANESTHESIOLOGY",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "61801",
            "telephone_number": "217-383-3141",
            "fax_number": "217-383-3265"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ETCHESON",
        "first_name": "STEVEN",
        "middle_name": "W",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2012-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209001440",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6447860011",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbana, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.