NPIMap

Individual provider Active NPI

Desiree Wickenhauser, CRNA

  • Certified Registered Nurse Anesthetist
  • Saint Louis, MO
National Provider Identifier
1912453945
Registry record updated May 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
209016063 Issued in IL
Practice address
11133 Dunn Rd
Saint Louis, MO 63136-6163
Phone
(314) 203-3041
NPI assigned
Aug 30, 2016
Last updated
May 31, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 31, 2024

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 2017002698 MO
Certified Registered Nurse Anesthetist 367500000X 209016063 IL Primary
Registered Nurse 163W00000X 041419907 IL
Registered Nurse 163W00000X 2011022892 MO

Addresses

Primary practice location

11133 Dunn Rd
Saint Louis, MO 63136-6163

Mailing address

11133 Dunn Rd
Saint Louis, MO 63136-6163

Other practice location 1

9515 Holy Cross Ln
Breese, IL 62230-3618
Phone (618) 526-5829

Other practice location 2

400 Maple Summit Rd
Jerseyville, IL 62052-2028
Phone (618) 498-6402

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO, IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170215002088 MO Practitioner - Certified Registered Nurse Anesthetist (Crna) 8628351798 Reassigns benefits to 5 organizations
I20170707001493 IL Practitioner - Certified Registered Nurse Anesthetist (Crna) 8628351798 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Southern Illinois University School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mercy Clinic Springfield CommunitiesGroup PAC ID 7416865845, 1,121 clinicians
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

1235 E Cherokee St
Springfield, MO 65804-2203

2115 S Fremont Ave
3050 MC Infectious Disease Whiteside
Springfield, MO 65804-2236
Phone (417) 820-3905

3045 S National Ave
Springfield, MO 65804-4268

611 W Park St
Urbana, IL 61801-2500

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
041419907ILMDRegistered Nurse
2011022892MOMDRegistered Nurse
209016063ILMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia of Southern Illinois LLC Nurse Anesthetist, Certified Registered CurrentSince Aug 15, 2021 Accepting new patients
Carle Health Medical Group CurrentSince Dec 15, 2025 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Apr 1, 2023 Accepting new patients
Aim Anesthesia LLC CurrentSince Sep 1, 2021 Accepting new patients
Midwest Anesthesia Providers S.C Nurse Anesthetist, Certified Registered CurrentSince Feb 13, 2017 Accepting new patients
Ips of St Louis LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 3, 2019 Accepting new patients
Ambulatory Anesthesia Services of St. Charles, LLC CurrentSince Dec 11, 2018 Accepting new patients
Mercy Clinic Springfield Communities CurrentSince Apr 1, 2023 Accepting new patients

Locations

1 Memorial Dr
Alton, IL 62002
Phone (618) 463-7240

2 Memorial Dr
Alton, IL 62002
Phone (618) 259-5096

2810 Frank Scott Pkwy W
Ste 716
Belleville, IL 62223
Phone (618) 355-0880

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

3550 McKelvey Rd
Bridgeton, MO 63044
Phone 31474109114048

11133 Dunn Rd
Saint Louis, MO 63136
Phone (314) 653-5000

12855 N 40 Dr
Saint Louis, MO 63141
Phone (314) 432-4415

8637 Delmar Blvd
Saint Louis, MO 63124
Phone (314) 880-0717

4203 S Cloverleaf Dr
Saint Peters, MO 63376
Phone (636) 346-6051

1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115

2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

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": "1472515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717113600000",
    "number": "1912453945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11133 DUNN RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366163"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11133 DUNN RD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631366163",
            "telephone_number": "314-203-3041"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9515 Holy Cross Ln",
            "address_purpose": "LOCATION",
            "city": "Breese",
            "state": "IL",
            "postal_code": "622303618",
            "country_code": "US",
            "telephone_number": "618-526-5829",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "400 Maple Summit Rd",
            "address_purpose": "LOCATION",
            "city": "Jerseyville",
            "state": "IL",
            "postal_code": "620522028",
            "country_code": "US",
            "telephone_number": "618-498-6402",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WICKENHAUSER",
        "first_name": "DESIREE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-30",
        "last_updated": "2024-05-31",
        "certification_date": "2024-05-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MO",
            "license": "2017002698",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "IL",
            "license": "209016063",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "IL",
            "license": "041419907",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MO",
            "license": "2011022892",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Louis, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 2024; 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.