NPIMap

Organization Active NPI

Millennium Anesthesiology Consultants, LLC

  • Anesthesiology Physician
  • Maryville, IL
National Provider Identifier
1710218094
Registry record updated Aug 6, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
MILLENNIUM ANESTHESIOLOGY CONSULTANTS, LLC
Practice address
6800 State Route 162
Maryville, IL 62062-8500
Phone
(618) 391-5589
Fax
(214) 301-0649
NPI assigned
Jan 26, 2010
Last updated
Aug 6, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2024

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

Authorized official

Name
Frederick Wagner, MDNPI 1770589053
Title
President
Phone
(618) 391-5589

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 Primary

Addresses

Primary practice location

6800 State Route 162
Maryville, IL 62062-8500

Mailing address

PO Box 616
Edwardsville, IL 62025-0616
Phone (833) 749-8324

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100630000117 IL Part B Supplier - Clinic/Group Practice 9133250475 Receives reassigned benefits from 42 practitioners
Practice locations: Maryville, IL

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 43

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 43

NPI Registry JSON

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

{
    "created_epoch": "1264464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1722902400000",
    "number": "1710218094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 616",
            "city": "EDWARDSVILLE",
            "state": "IL",
            "postal_code": "620250616",
            "telephone_number": "833-749-8324",
            "fax_number": "214-301-0649"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6800 STATE ROUTE 162",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620628500",
            "telephone_number": "618-391-5589",
            "fax_number": "214-301-0649"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLENNIUM ANESTHESIOLOGY CONSULTANTS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-26",
        "last_updated": "2024-08-06",
        "certification_date": "2024-08-06",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "FREDERICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-391-5589",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2024; 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.