Martha Harris, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Belleville, IL
NPI 1841241676 · NPPES record last updated Mar 3, 2017
Key facts
- NPI
- 1841241676
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- 94978 (MO)
- Practice address
- 311 W Lincoln St
Suite 201
Belleville, IL 62220-1902 - Phone
- (618) 222-3200
- Fax
- (618) 222-3203
- NPI assigned
- May 15, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Specialists in Anesthesia PC
Practice addresses (Care Compare)
5900 Bond Ave
Centreville, IL 62207-2326
Phone (618) 332-5480
Hospital & facility affiliations
- Touchette Regional Hospital Inc
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20081121000156 | IL | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 0042205734 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 94978 | MO | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Diabetes Thyroid and Osteoporosis Clinic of Southern Illinois LTD | Past | Accepting new patients | |
| Metro East Gastroenterology LTD | Past |
Accepting new patients | |
| Sluh Anesthesia Physicians, L.L.C. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 94978 | MO | Yes |
Addresses
Primary practice location
311 W Lincoln St
Suite 201
Belleville, IL 62220-1902
Mailing address
311 W Lincoln St
Suite 201
Belleville, IL 62220-1902
Phone (618) 222-3200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 915102420 | Medicaid | MO |
Other providers in Belleville, IL
- Amanda Hargan
- Samantha Harlan
- Harmony Emge School Dist 175
- Angie Mills Harris
- Dean Chris Harris
- Chester Earl Harrison
- Jason G Harrison
- Amanda M Hart
- Brandy Hart
- Brian James Hart
All providers in Belleville, IL · Certified Registered Nurse Anesthetist in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 3, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.