NPIMap

Organization Active NPI

Stat Anesthesia Specialists LTD

  • Anesthesiology Physician
  • Saint John, IN
National Provider Identifier
1699724781
Registry record updated Nov 21, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
64718096 Issued in IL
Legal business name
STAT ANESTHESIA SPECIALISTS LTD
Practice address
10220 Wicker Ave
Suite 3
Saint John, IN 46373-9424
Phone
(219) 515-6943
Fax
(708) 895-9455
NPI assigned
May 8, 2006
Reactivated
Oct 23, 2013
Last updated
Nov 21, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2017

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

Authorized official

Name
Peter J Pollachek, CRNANPI 1912902040
Title
President
Phone
(708) 805-8900

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 64718096 IL Primary

Addresses

Primary practice location

10220 Wicker Ave
Suite 3
Saint John, IN 46373-9424

Mailing address

18221 Torrence Ave
Suite 1B
Lansing, IL 60438-2870
Phone (708) 895-9450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070529000372 IN Part B Supplier - Clinic/Group Practice 8123031473 Receives reassigned benefits from 98 practitioners
1 other NPI on this enrollment
Practice locations: Saint John, IN; Valparaisio, IN; Schererville, IN; Munster, IN; Merrillville, IN; La Porte, IN; Highland, IN; Hammond, IN…

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Stat Anesthesia Specialists LTD2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10220 Wicker Ave
Ste 3
Saint John, IN 46373
Phone (219) 515-6943

Practitioners & affiliated clinicians

Practitioners 103

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 103

NPI Registry JSON

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

{
    "created_epoch": "1147046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511222400000",
    "number": "1699724781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18221 TORRENCE AVE",
            "address_2": "SUITE 1B",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604382870",
            "telephone_number": "708-895-9450",
            "fax_number": "708-895-9455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10220 WICKER AVE",
            "address_2": "SUITE 3",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463739424",
            "telephone_number": "219-515-6943",
            "fax_number": "708-895-9455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STAT ANESTHESIA SPECIALISTS LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-08",
        "last_updated": "2017-11-21",
        "deactivation_date": "2013-08-28",
        "reactivation_date": "2013-10-23",
        "status": "A",
        "authorized_official_last_name": "POLLACHEK",
        "authorized_official_first_name": "PETER",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-805-8900",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "64718096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint John, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2017; 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.