Individual provider Active NPI

Adrian M. Nowitzke, CRNA

  • Certified Registered Nurse Anesthetist
  • Mattoon, IL
National Provider Identifier
1720404759
Registry record updated Nov 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209011267 Issued in IL
Practice address
1000 Health Center Dr
Mattoon, IL 61938-4644
Phone
(217) 258-2440
NPI assigned
Mar 14, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 12, 2024

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 209011267 IL Primary

Addresses

Primary practice location

1000 Health Center Dr
Mattoon, IL 61938-4644

Mailing address

PO Box 372
Mattoon, IL 61938-0372

Other practice location 1

503 N Maple St
Effingham, IL 62401-2006
Phone (217) 347-1361

Other practice location 2

904 W Temple Ave
Effingham, IL 62401-2178
Phone (217) 342-1234

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140523002047 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 2668695487 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sarah Bush Lincoln Health CenterGroup PAC ID 5092614867, 411 clinicians

Practice addresses (Care Compare)

1000 Health Ctr Dr
Mattoon, IL 61938-4644
Phone (217) 258-2525

Hospital & facility affiliations

  • Sarah Bush Lincoln Health Center Hospital, Mattoon, IL, CCN 140189

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Sarah Bush Lincoln Health Center CurrentSince Apr 15, 2022 Accepting new patients
Sarah Bush Lincoln Health Center CurrentSince Apr 15, 2022 Accepting new patients
G & G Anesthesia LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2021 Accepting new patients

Locations

1 Saint Anthonys Way
Alton, IL 62002
Phone (618) 233-6870

503 N Maple St
Effingham, IL 62401
Phone (217) 342-2121

904 W Temple Ave
Effingham, IL 62401
Phone (217) 342-1234

1005 Health Center Dr
Ste 201
Mattoon, IL 61938
Phone (217) 238-6055

101 Professional Plz
Mattoon, IL 61938
Phone (217) 238-3730

1000 Health Center Dr
Mattoon, IL 61938
Phone (217) 258-2389

8 Doctors Park Rd
Mount Vernon, IL 62864
Phone (618) 244-5500

Organizations & group practices 3

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1394755200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731369600000",
    "number": "1720404759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 372",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619380372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 HEALTH CENTER DR",
            "city": "MATTOON",
            "state": "IL",
            "postal_code": "619384644",
            "telephone_number": "217-258-2440"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "503 N Maple St",
            "address_purpose": "LOCATION",
            "city": "Effingham",
            "state": "IL",
            "postal_code": "624012006",
            "country_code": "US",
            "telephone_number": "217-347-1361",
            "fax_number": "217-347-1412",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "904 W Temple Ave",
            "address_purpose": "LOCATION",
            "city": "Effingham",
            "state": "IL",
            "postal_code": "624012178",
            "country_code": "US",
            "telephone_number": "217-342-1234",
            "fax_number": "217-342-1230",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NOWITZKE",
        "first_name": "ADRIAN",
        "middle_name": "M.",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-14",
        "last_updated": "2024-11-12",
        "certification_date": "2024-11-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209011267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mattoon, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2024; 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.