NPIMap

Organization Active NPI

Glen Elyn Anesthesia Associates, LLC

  • Certified Registered Nurse Anesthetist
  • Lutherville, MD
National Provider Identifier
1831391036
Registry record updated Sep 26, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R063574 Issued in MD
Legal business name
GLEN ELYN ANESTHESIA ASSOCIATES, LLC
Practice address
10751 Falls Rd
Suite 425
Lutherville, MD 21093-4517
Phone
(410) 583-2760
Fax
(410) 583-2759
NPI assigned
Jun 1, 2007
Last updated
Sep 26, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 26, 2007

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

Authorized official

Name
Mr. Stephen Wilson, CRNANPI 1255323630
Title
President
Phone
(410) 557-6724

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R063574 MD Primary

Addresses

Primary practice location

10751 Falls Rd
Suite 425
Lutherville, MD 21093-4517

Mailing address

3101 Morningside CT
Baldwin, MD 21013-9528
Phone (410) 557-6724

Other identifiers 3

IdentifierTypeStateIssuer
KCE3GLOtherMDBLUE CROSS BLUE SHIELD
S4320001OtherMDFEDERAL CAREFIRST
P00012294OtherMDMEDICARE RAILROAD

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1180656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1190764800000",
    "number": "1831391036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 MORNINGSIDE CT",
            "city": "BALDWIN",
            "state": "MD",
            "postal_code": "210139528",
            "telephone_number": "410-557-6724",
            "fax_number": "410-557-4355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10751 FALLS RD",
            "address_2": "SUITE 425",
            "city": "LUTHERVILLE",
            "state": "MD",
            "postal_code": "210934517",
            "telephone_number": "410-583-2760",
            "fax_number": "410-583-2759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN ELYN ANESTHESIA ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-01",
        "last_updated": "2007-09-26",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "STEPHEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-557-6724",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MD",
            "license": "R063574",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "KCE3GL",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL CAREFIRST",
            "identifier": "S4320001",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "P00012294",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lutherville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.