NOVAMED EYE SURGERY CENTER OF MARYVILLE, LLC (NPI# 1023055696) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1023055696 |
| Entity Type | Organization |
| Organization Name | NOVAMED EYE SURGERY CENTER OF MARYVILLE, LLC |
| Other Organization Name | EYES OF ILLINOIS SURGERY CENTER OF MARYVILLE |
| Practice Address |
12 Maryville Professional Park Maryville IL 62062 |
| Mailing Address |
12 Professional Park Dr Maryville IL 62062-5672 |
| Practice Telephone | 6182887483 |
| Practice Fax Number | 6182887196 |
| Mailing Telephone | 6182887483 |
| Mailing Fax Number | 6182887196 |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | MR. SCOTT T. MACOMBER (EXECUTIVE VP AND CFO) |
| Authorized Official Telephone | 3127803234 |
| Is Organization Subpart | Y |
| Parent Organization Name | NOVAMED, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | 7002132 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS OF IL | 0006032183 | 01 |
| Other Name | Type Code |
|---|---|
| Eyes of Illinois Surgery Center of Maryville | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386641066 | Novamed Eye Surgery Center of Maryville, LLC | Clinic/Center | 12 Professional Park Dr, Maryville, IL 62062-5672 | 2005-07-07 |
| Street Address |
12 MARYVILLE PROFESSIONAL PARK |
| City | MARYVILLE |
| State | IL |
| Zip Code | 62062 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104325091 | Jennifer M Oyler | Physician Assistant | 6812 State Route 162 Suite 120, Maryville, IL 62062 | 2018-02-06 |
| 1710495965 | Sarah Elizabeth Barto | Family Medicine | 2133 Vadalabene Drive, Suite Sb, Maryville, IL 62062 | 2018-01-22 |
| 1104348085 | Lindsey Nicole Langendorf | Chiropractor | 62 Executive Plaza Ct, Maryville, IL 62062 | 2017-07-12 |
| 1043750540 | Gina Saal | Nurse Anesthetist, Certified Registered | 6800 Rt 162, Maryville, IL 62062 | 2017-03-02 |
| 1548657737 | Karen Michelle Bertels | Emergency Medicine | 6800 Il - 162, Maryville, IL 62062 | 2015-04-25 |
| 1811258148 | Debra Ann Hoelscher | Internal Medicine | 2102 Vadalabene, Maryville, IL 62062 | 2012-06-04 |
| 1538438445 | Casey Elizabeth Wiesemeyer | Speech-Language Pathologist | 2201 Copper Creek Rd, Maryville, IL 62062 | 2011-12-21 |
| 1407144819 | Norah Claire Farley Baker | Family Medicine | 10 Professional Park Dr., Maryville, IL 62062 | 2011-07-19 |
| 1891092474 | Kimberly M Schneider | Physician Assistant | 20b Professional Park Drive, Maryville, IL 62062 | 2011-02-17 |
| 1669782397 | Purandhri Patel | Physical Therapist | 6820 State Route 162, Maryville, IL 62062 | 2010-10-15 |
| Find all providers in zip 62062 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043750540 | Gina Saal | Nurse Anesthetist, Certified Registered | 6800 Rt 162, Maryville, IL 62062 | 2017-03-02 |
| 1952709446 | David Kinlaw | Nurse Anesthetist, Certified Registered | 2903 W Woodbine Dr, Maryville, TN 37803-0591 | 2014-12-15 |
| 1598373052 | Brittany Smith | Nurse Anesthetist, Certified Registered | 6800 State Route 162, Maryville, IL 62062-8500 | 2020-07-21 |
| 1285251033 | Cory Ray Austin | Nurse Anesthetist, Certified Registered | 6800 State Route 162, Maryville, IL 62062-8500 | 2020-06-28 |
| 1194210393 | Jared T Holton | Nurse Anesthetist, Certified Registered | 6800 State Route 162, Maryville, IL 62062-8500 | 2018-06-29 |
| 1396235933 | Amy Catherine Schollenberger | Nurse Anesthetist, Certified Registered | 6800 State Route 162, Maryville, IL 62062-8500 | 2018-05-17 |
| 1760905855 | Coleen Michele Spotts | Nurse Anesthetist, Certified Registered | 907 E Lamar Alexander Pkwy, Maryville, TN 37804-5015 | 2017-07-20 |
| 1841713955 | Tiffany Michelle Foster | Nurse Anesthetist, Certified Registered | 907 E Lamar Alexander Pkwy, Maryville, TN 37804-5015 | 2017-07-20 |
| 1124541248 | Donna Marie Mcmahan | Nurse Anesthetist, Certified Registered | 907 E Lamar Alexander Pkwy, Maryville, TN 37804-5015 | 2017-07-20 |
| 1164962817 | Connie Ann Dumm | Nurse Anesthetist, Certified Registered | 6800 State Route 162, Maryville, IL 62062-8500 | 2017-02-28 |
| Find all providers in MARYVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.