MR. PHILLIP DUSTIN DEBERRY (NPI# 1831608363) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831608363 |
| Entity Type | Individual |
| Full Name | MR. PHILLIP DUSTIN DEBERRY |
| Credential | CRNA |
| Practice Address |
405 W Jackson St Carbondale IL 62901-1462 |
| Mailing Address |
755 Stone Creek Dr Makanda IL 62958-2735 |
| Practice Telephone | 6185490721 |
| Mailing Telephone | 2104609566 |
| Enumeration Date | 2017-09-27 |
| Last Update Date | 2017-09-27 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 367500000X | Nurse Anesthetist, Certified Registered | 209.016634 | IL | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
405 W JACKSON ST |
| City | CARBONDALE |
| State | IL |
| Zip Code | 62901-1462 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194726851 | Shahriar Bozorgzadeh | Emergency Medicine | 405 W Jackson St, Carbondale, IL 62901-1462 | 2005-08-03 |
| 1568071132 | Cynthia Sue Davis | Nurse Practitioner | 405 W Jackson St, Carbondale, IL 62901-1462 | 2020-07-29 |
| 1629686019 | Dianne Zuasula Catolos | Physical Therapist | 405 W Jackson St, Carbondale, IL 62901-1462 | 2020-07-21 |
| 1871113696 | Summer R Black | Nurse Anesthetist, Certified Registered | 405 W Jackson St, Carbondale, IL 62901-1462 | 2020-04-22 |
| 1871123067 | Hailee Elizabeth Bowlin | Nurse Practitioner | 405 W Jackson St, Carbondale, IL 62901-1462 | 2020-01-16 |
| 1972061737 | Briana Nichole Jones | Speech-Language Pathologist | 405 W Jackson St, Carbondale, IL 62901-1462 | 2019-03-11 |
| 1700362183 | John Grady Johnston Jr. | Registered Nurse | 405 W Jackson St, Carbondale, IL 62901 | 2018-07-18 |
| 1972099067 | Andrew Mcnally | Nurse Anesthetist, Certified Registered | 405 W Jackson St, Carbondale, IL 62901-1462 | 2018-07-02 |
| 1134610587 | Megan E Sims | Nurse Anesthetist, Certified Registered | 405 W Jackson St, Carbondale, IL 62901-1462 | 2018-05-22 |
| 1447749833 | Erika Diericx | Pharmacist | 405 W Jackson St, Carbondale, IL 62901-1462 | 2018-05-01 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558961268 | Gerad Aaron Harsy | Pharmacist | Walmart Pharmcy, 1450 East Main St, Carbondale, IL 62901 | 2020-10-30 |
| 1437708674 | Board of Trustees of Southern Illinois University | Clinic/Center | 300 W Oak Street, Carbondale, IL 62901 | 2019-09-10 |
| 1306317383 | Rachael O Johnson | Nurse Practitioner | 404 S. Lewis Ln, Carbondale, IL 62901 | 2018-12-17 |
| 1740795194 | Megan Marie Zimmerman | Nurse Practitioner | 1100 W Diann Ln., Carbondale, IL 62901 | 2017-12-07 |
| 1295244242 | Amy Elizabeth Prudencio | Social Worker | 1301 E. Walnut Street, Carbondale, IL 62901 | 2017-09-21 |
| 1740708171 | Theresa Aleise Goodin | Speech-Language Pathologist | 1301 East Walnut Street, Carbondale, IL 62901 | 2017-09-06 |
| 1144762527 | Kathleen Chwalisz Rigney | Psychologist | 306 West Mill Street, Neurorestorative, Carbondale, IL 62901 | 2016-11-16 |
| 1285185173 | Shawnee Health Service and Development Corp | Social Worker | 404 S. Lewis Lane, Carbondale, IL 62901 | 2016-10-17 |
| 1437605094 | Arielle Greer | Nurse's Aide | 510 E. Russell St., A, Carbondale, IL 62901 | 2016-09-01 |
| 1518413863 | Complete Family Eyecare of Carbondale, PC | Optometrist | 1241 East Walnut Street, Carbondale, IL 62901 | 2016-08-28 |
| Find all providers in zip 62901 | ||||
| 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 |
|---|---|---|---|---|
| 1639223464 | James David Wade | Nurse Anesthetist, Certified Registered | 35 Albany Rd Ste C, Carbondale, IL 62903-7605 | 2007-01-22 |
| 1811949910 | Devon G Barnes | Nurse Anesthetist, Certified Registered | 35 Albany Road, Suite C, Carbondale, IL 62903 | 2006-05-17 |
| 1811989627 | Pamela Kay Sparling | Nurse Anesthetist, Certified Registered | 450 W Jackson St, Dba Sih Medical Group Anesthesiology, Carbondale, IL 62901-1463 | 2005-08-17 |
| 1871113696 | Summer R Black | Nurse Anesthetist, Certified Registered | 405 W Jackson St, Carbondale, IL 62901-1462 | 2020-04-22 |
| 1972099067 | Andrew Mcnally | Nurse Anesthetist, Certified Registered | 405 W Jackson St, Carbondale, IL 62901-1462 | 2018-07-02 |
| 1134610587 | Megan E Sims | Nurse Anesthetist, Certified Registered | 405 W Jackson St, Carbondale, IL 62901-1462 | 2018-05-22 |
| 1861991671 | Ashley Marie Browning | Nurse Anesthetist, Certified Registered | 1239 E Main St, Carbondale, IL 62901-3175 | 2018-02-07 |
| 1306358445 | Eric David Wagner | Nurse Anesthetist, Certified Registered | 405 W Jackson St, Carbondale, IL 62901-1462 | 2017-10-30 |
| 1205346483 | Britley Ann White | Nurse Anesthetist, Certified Registered | 405 W Jackson St, Carbondale, IL 62901-1462 | 2017-10-02 |
| 1073031936 | Nathaniel C Crum | Nurse Anesthetist, Certified Registered | 405 W Main St, Carbondale, IL 62901-2903 | 2017-08-31 |
| Find all providers in CARBONDALE | ||||
| City | CARBONDALE |
| Zip Code | 62901 |
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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.