Ellen Africano Wagner, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

209.012203 Issued in IL

Practice address

19624 Governors Hwy
Flossmoor, IL 60422-2077

Phone

(708) 798-5838

Fax

(708) 798-5865

NPI assigned

Sep 24, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lake Anesthesia AssociatesGroup PAC ID 9830287416, 8 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

95 of 100Reported as group

Quality

90

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

State licenses

Practice roles

Locations

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.

• Lake Anesthesia Associates

  • Certified Registered Nurse Anesthetist
  • Flossmoor, IL
  • NPI 1528260635

  Nurse Anesthetist, Certified Registered

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1411516800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1679975411",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1713 N VINE ST",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606145119",
            "telephone_number": "312-513-2177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19624 GOVERNORS HWY",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "604222077",
            "telephone_number": "708-798-5838",
            "fax_number": "708-798-5865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ELLEN",
        "middle_name": "AFRICANO",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-24",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041372498",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209.012203",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ni Van, DMD
• Aleshia Varnado
• Village of Flossmoor
• Mahim K Vora, MD
• VSH Health LLC
• Nancy Alice Wahlstrom, CSFA/CST
• Lisa Ann Waldroup
• Amanda Walker
• Jamia Rachelle Walker, LCPC
• Romuald C Warakomski, D.O.

• Certified Registered Nurse Anesthetist in Flossmoor, IL
• Providers in Flossmoor, IL by specialty
• Certified Registered Nurse Anesthetist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.