Active NPI
Salem Township Hospital
- Certified Registered Nurse Anesthetist
- Salem, IL
National Provider Identifier
1770649931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 0002089
- Legal business name
- SALEM TOWNSHIP HOSPITAL
- Practice address
- 1201 Ricker Drive
Salem, IL 62881 - Phone
- (618) 548-3194
- Fax
- (618) 548-6831
- NPI assigned
- Dec 29, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Alexander Nazarian
- Title
- President/Ceo/Cfo
- Phone
- (618) 548-3194
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 0002089 | IL | Primary |
Addresses
Primary practice location
1201 Ricker Drive
Salem, IL 62881
Mailing address
1201 Ricker Drive
Salem, IL 62881
Phone (618) 548-3194
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031126000688 | IL | Part B Supplier - Clinic/Group Practice | 0840195277 |
Receives reassigned benefits from 42 practitioners 6 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Salem, IL |
Other NPIs on the same Medicare enrollment 6
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
- Clinical Cardiac Electrophysiology Physician
- Salem, IL
- NPI 1518024637
O20031126000688
National Provider Directory
National Provider DirectoryNPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1629849600000",
"number": "1770649931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1201 RICKER DRIVE",
"city": "SALEM",
"state": "IL",
"postal_code": "62881",
"telephone_number": "618-548-3194",
"fax_number": "618-548-6831"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1201 RICKER DRIVE",
"city": "SALEM",
"state": "IL",
"postal_code": "62881",
"telephone_number": "618-548-3194",
"fax_number": "618-548-6831"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SALEM TOWNSHIP HOSPITAL",
"organizational_subpart": "NO",
"enumeration_date": "2006-12-29",
"last_updated": "2021-08-25",
"certification_date": "2021-08-25",
"status": "A",
"authorized_official_last_name": "NAZARIAN",
"authorized_official_first_name": "ALEXANDER",
"authorized_official_title_or_position": "PRESIDENT/CEO/CFO",
"authorized_official_telephone_number": "618-548-3194"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "IL",
"license": "0002089",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salem, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2021; 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.