Individual provider Active NPI

Lesa Renee' Seales, AA-C

  • Anesthesiologist Assistant
  • Belleville, IL
National Provider Identifier
1811969892
Registry record updated Jul 27, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiologist AssistantTaxonomy code 367H00000X
License
161D
Practice address
211 S. 3Rd St.
Belleville, IL 62221
Phone
(618) 234-2120
Fax
(618) 641-5410
NPI assigned
Feb 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiologist Assistant 367H00000X 2009028903 MO
Anesthesiologist Assistant 367H00000X 161D Primary
Pain Management Registered Nurse 163WP0000X AA NOT LIC. BY STATE IL

Addresses

Primary practice location

211 S. 3Rd St.
Belleville, IL 62221

Mailing address

3215 Executive Park Dr.
HSHS Medical Group
Springfield, IL 62703
Phone (618) 234-2120

Other names 1

  • Miss Lesa Renee' Stoecklin Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220803001960 MO Practitioner - Anesthesiology Assistant 9032168620 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology Assistant
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
SSM Health Slu Hospital Anesthesia Physician Billing LLCGroup PAC ID 3274842331, 98 clinicians

Practice addresses (Care Compare)

1201 S Grand Blvd
Saint Louis, MO 63104-1016
Phone (314) 257-8000

1225 S Grand Blvd
Saint Louis, MO 63104-1016
Phone (314) 257-8000

Hospital & facility affiliations

  • SSM Health Saint Louis University Hospital Hospital, Saint Louis, MO, CCN 260105

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Associate of Arts

State licenses

LicenseStateTypeSpecialty
AA NOT LIC. BY STATEILMDPain Management Registered Nurse
2009028903MOMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
SSM Health Slu Hospital Anesthesia Physician Billing, LLC Anesthesiologist Assistant CurrentSince Aug 1, 2022 Accepting new patients

Locations

1201 S Grand Blvd
Saint Louis, MO 63104
Phone (314) 257-8222

Organizations & group practices 1

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": "1138924800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658880000000",
    "number": "1811969892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3215 EXECUTIVE PARK DR.",
            "address_2": "HSHS MEDICAL GROUP",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "62703",
            "telephone_number": "618-234-2120",
            "fax_number": "618-641-5410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "211 S. 3RD ST.",
            "city": "BELLEVILLE",
            "state": "IL",
            "postal_code": "62221",
            "telephone_number": "618-234-2120",
            "fax_number": "618-641-5410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEALES",
        "first_name": "LESA",
        "middle_name": "RENEE'",
        "name_prefix": "Mrs.",
        "credential": "AA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-03",
        "last_updated": "2022-07-27",
        "certification_date": "2022-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": "MO",
            "license": "2009028903",
            "primary": false
        },
        {
            "code": "367H00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiologist Assistant",
            "state": null,
            "license": "161D",
            "primary": true
        },
        {
            "code": "163WP0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pain Management",
            "state": "IL",
            "license": "AA NOT LIC. BY STATE",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LESA",
            "last_name": "STOECKLIN",
            "middle_name": "RENEE'",
            "prefix": "MISS",
            "credential": "AA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Belleville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2022; 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.