NPIMap

Individual provider Active NPI

David L Stittsworth, CRNA

  • Certified Registered Nurse Anesthetist
  • Mount Vernon, IL
National Provider Identifier
1689636540
Registry record updated Dec 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209000982 Issued in IL
Practice address
17713 E Shadow Lake Rd
Mount Vernon, IL 62864-8136
Phone
(618) 244-2336
Fax
(618) 244-1993
NPI assigned
Apr 5, 2006
Last updated
Dec 8, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2021

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 209000982 IL Primary

Addresses

Primary practice location

17713 E Shadow Lake Rd
Mount Vernon, IL 62864-8136

Mailing address

17713 E Shadow Lake Rd
Mount Vernon, IL 62864-8136
Phone (618) 244-2336

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address dstittsworth298640@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

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

LicenseStateTypeSpecialty
209000982ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Sparta Community Hospital D/B/a Quality Healthcare Clinics PastSince Mar 1, 2019 Accepting new patients
Laboratory Corportation of America Holdings Past Accepting new patients
Baptist Memorial Hospital-Desoto, Inc, Past Accepting new patients
Marion Hospital Corporation Nurse Anesthetist, Certified Registered Past Accepting new patients
Anesthesiology Consultants of Toledo, Inc Past Accepting new patients
Premier Anesthesia of Danville Past Accepting new patients
Associated Anesthesiologists, S.C. Past Accepting new patients
Brigham Anesthesia South LLC PastSince Jun 1, 2004 Accepting new patients
Topeka Anesthesia & Pain Treatment, P.a. Nurse Anesthetist, Certified Registered Past Accepting new patients
Amsol Anesthetists of Illinois, PC Nurse Anesthetist, Certified Registered Past Accepting new patients
Sparta Community Hospital D/B/a Quality Healthcare Clinics PastSince May 21, 2023 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: dstittsworth298640@direct.myadvocateaurora.org

Organizations & group practices 11

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

NPI Registry JSON

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638921600000",
    "number": "1689636540",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17713 E SHADOW LAKE RD",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628648136",
            "telephone_number": "618-244-2336",
            "fax_number": "618-244-1993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17713 E SHADOW LAKE RD",
            "city": "MOUNT VERNON",
            "state": "IL",
            "postal_code": "628648136",
            "telephone_number": "618-244-2336",
            "fax_number": "618-244-1993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STITTSWORTH",
        "first_name": "DAVID",
        "middle_name": "L",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209000982",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dstittsworth298640@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "17713 E Shadow Lake Rd",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628648136",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "17713 E Shadow Lake Rd",
            "city": "Mount Vernon",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628648136",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Vernon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2021; 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.