Individual provider Active NPI

Sandra Smith-Lex, CRNA

  • Certified Registered Nurse Anesthetist
  • Springfield, IL
National Provider Identifier
1770571648
Registry record updated Oct 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209001446 Issued in IL
Practice address
800 East Carpenter Street
Room 2K64
Springfield, IL 62769-0001
Phone
(217) 525-5643
Fax
(217) 544-2521
NPI assigned
Oct 13, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 16, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 041229268 IL
Certified Registered Nurse Anesthetist 367500000X 209001446 IL Primary

Addresses

Primary practice location

800 East Carpenter Street
Room 2K64
Springfield, IL 62769-0001

Mailing address

800 East Carpenter Street
Room 2K64
Springfield, IL 62769-0001
Phone (217) 525-5643

Other identifiers 4

IdentifierTypeStateIssuer
041229268OtherILIL STATE LICENSE #
031312OtherILHEALTH ALLIANCE NUMBERS
209-005625OtherILIL APN LICENSE #
45622OtherILAANA#

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110128000782 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 2466631981 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Medical CenterGroup PAC ID 7315835949, 131 clinicians

Practice addresses (Care Compare)

701 N 1St St
Springfield, IL 62781-0001
Phone (217) 788-3755

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041229268ILMDCertified Registered Nurse Anesthetist
209001446ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Memorial Medical Center Nurse Anesthetist, Certified Registered CurrentSince May 23, 2000 Accepting new patients
Memorial Medical Center CurrentSince May 23, 2000 Accepting new patients
Sangamon Associated Anesthesiologists, S.C. Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

701 N 1st St
Springfield, IL 62781
Phone (217) 788-3100

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": "1129161600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1381881600000",
    "number": "1770571648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 EAST CARPENTER STREET",
            "address_2": "ROOM 2K64",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627690001",
            "telephone_number": "217-525-5643",
            "fax_number": "217-544-2521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 EAST CARPENTER STREET",
            "address_2": "ROOM 2K64",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627690001",
            "telephone_number": "217-525-5643",
            "fax_number": "217-544-2521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMITH-LEX",
        "first_name": "SANDRA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-10-13",
        "last_updated": "2013-10-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "041229268",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209001446",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL STATE LICENSE #",
            "identifier": "041229268",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE NUMBERS",
            "identifier": "031312",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL APN LICENSE #",
            "identifier": "209-005625",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AANA#",
            "identifier": "45622",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2013; 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.