DR. SHANE R FANCHER (NPI# 1427055433) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1427055433 |
| Entity Type | Individual |
| Full Name | DR. SHANE R FANCHER |
| Credential | MD |
| Practice Address |
1800 E Lake Shore Dr Decatur IL 62521-3810 |
| Mailing Address |
4160 S Lake Ct Decatur IL 62521-8440 |
| Practice Telephone | 2174642729 |
| Practice Fax Number | 2174641693 |
| Mailing Telephone | 2174259665 |
| Mailing Fax Number | 2174259664 |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2015-09-01 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207L00000X | Anesthesiology | ME93432 | FL | Allopathic & Osteopathic Physicians |
| N | 207L00000X | Anesthesiology | 24559 | SC | Allopathic & Osteopathic Physicians |
| N | 207L00000X | Anesthesiology | 036-094339 | IL | Allopathic & Osteopathic Physicians |
| N | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
ME93432 | FL | Allopathic & Osteopathic Physicians |
| N | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
24559 | SC | Allopathic & Osteopathic Physicians |
| Y | 207LP2900X |
Anesthesiology Specialization: Pain Medicine |
036-094339 | IL | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | ME93432 | FL | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | 24559 | SC | Allopathic & Osteopathic Physicians |
| N | 208600000X | Surgery | 036-094339 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS | 336055454 | 01 |
| IL | 036094339 | 05 |
| Street Address |
1800 E LAKE SHORE DR |
| City | DECATUR |
| State | IL |
| Zip Code | 62521-3810 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326041229 | St Marys Hospital Sisters of The Third Order of St Francis | General Acute Care Hospital | 1800 E Lake Shore Dr, Decatur, IL 62521 | 2005-05-24 |
| 1093349912 | Nicholas Halford | Nurse Anesthetist, Certified Registered | 1800 E Lake Shore Dr, Decatur, IL 62521-3810 | 2020-02-29 |
| 1295368207 | Amanda Durbin | Nurse Anesthetist, Certified Registered | 1800 E Lake Shore Dr, Decatur, IL 62521-3810 | 2020-02-18 |
| 1194362392 | Cassie Briggs | Nurse Practitioner | 1800 E Lake Shore Dr, Decatur, IL 62521-3883 | 2019-12-06 |
| 1093351413 | Megan Leech | Advanced Practice Midwife | 1800 E Lake Shore Dr, Decatur, IL 62521-3810 | 2019-11-20 |
| 1992355812 | Gideon Nkrumah | Nurse Anesthetist, Certified Registered | 1800 E Lake Shore Dr, Decatur, IL 62521-3883 | 2019-09-12 |
| 1407417181 | Komal J Patel | Dietitian, Registered | 1800 E Lake Shore Dr, Decatur, IL 62521-3810 | 2019-06-24 |
| 1760940712 | Emily Ann Foster | Internal Medicine | 1800 E Lake Shore Dr, Decatur, IL 62521-3810 | 2019-03-08 |
| 1477010874 | Jennifer Diann Pieper | Nurse Anesthetist, Certified Registered | 1800 E Lake Shore Dr, Decatur, IL 62521-3810 | 2019-02-22 |
| 1760955298 | Hailey Michelle Williams | Dietitian, Registered | 1800 E Lake Shore Dr, Decatur, IL 62521-3810 | 2019-01-08 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053927988 | Caleb David Braasch | Pharmacist | 1818 South Airport Rd, Decatur, IL 62521 | 2020-09-16 |
| 1295390490 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | Crossing Recovery Center, 495 East Central Ave, Decatur, IL 62521 | 2019-05-03 |
| 1396300638 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 E Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1679138911 | Crossing Recovery Center | Substance Abuse Rehabilitation Facility | 495 East Central Ave, Decatur, IL 62521 | 2019-05-02 |
| 1154848034 | Zack Shaw | Physical Therapist | 4855-57 East 36, Decatur, IL 62521 | 2017-08-23 |
| 1790032852 | Prashant Morolia | Family Medicine | 4775 E Maryland St, Decatur, IL 62521 | 2012-08-08 |
| 1003188913 | Evergreen Place Decatur, LLC | Assisted Living Facility | 4825 E Evergreen Court, Decatur, IL 62521 | 2012-02-08 |
| 1104133099 | Suzette Marie Shafer | Occupational Therapy Assistant | 1790 S. Fairview Ave., Decatur, IL 62521 | 2010-09-13 |
| 1467784090 | Community Health Improvement Center | Clinic/Center | 1221 East Condit Street, Decatur, IL 62521 | 2010-02-08 |
| 1982839056 | Kelly Clark Dds PC | Dentist | 3737 Us Rt 36 E, Decatur, IL 62521 | 2009-05-19 |
| Find all providers in zip 62521 | ||||
| Taxonomy Code | 207LP2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Anesthesiology |
| Specialization | Pain Medicine |
| An anesthesiologist who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic and/or cancer pain in both hospital and ambulatory settings. Patient care needs are also coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Anesthesiology, 2007. http://www.theaba.org/; American Osteopathic Board of Anesthesiology, 2007, http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Anesthesiology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Anesthesiology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093331423 | Premier Healthcare Center Corp | Anesthesiology | 4153 Flat Shoals Pkwy Ste 102, Decatur, GA 30034-4106 | 2020-06-22 |
| 1902987431 | Ahmad Shikhtholth | Anesthesiology | 2208 Danville Rd Sw, Suite G, Decatur, AL 35601-4603 | 2006-10-18 |
| 1336792019 | Georgia Pain and Spine Institute, PC | Anesthesiology | 2784 N Decatur Rd Ste 120, Decatur, GA 30033-5993 | 2019-07-22 |
| 1093270860 | Ved V. Aggarwal, Md, Pa | Anesthesiology | 1101 W Eagle Dr Ste B, Decatur, TX 76234-3721 | 2019-02-06 |
| 1568840684 | Physynergy, LLC | Anesthesiology | 1874 Beltline Rd Sw, Decatur, AL 35601-5514 | 2015-05-08 |
| 1386944239 | Valley Pain Clinic LLC | Anesthesiology | 2506 Danville Rd Sw, Suite 206, Decatur, AL 35603-4232 | 2010-10-26 |
| 1114244969 | Jerry Kalangara | Anesthesiology | 250 N Arcadia Ave, Decatur, GA 30030-2115 | 2010-05-03 |
| 1952560013 | Anesthesia Services, LLC | Anesthesiology | 1800 E Lake Shore Dr, Suite 2500, Decatur, IL 62521-3810 | 2008-06-04 |
| 1497959936 | Pain Consultants of Central Illinois LLC | Anesthesiology | 1800 E Lake Shore Dr, Suite 2500, Decatur, IL 62521-3810 | 2007-06-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538775770 | Regenerative Pain & Spine LLC | Anesthesiology | 2122 W Devon Ave, Chicago, IL 60659-3581 | 2020-09-22 |
| 1215552880 | Babu Prasad, Md | Anesthesiology | 2035 W Iles Ave Ste A, Springfield, IL 62704-7000 | 2020-06-10 |
| 1093330516 | Modern Pain Consultants | Anesthesiology | 1802 N Division St Ste 605, Morris, IL 60450-3133 | 2020-06-10 |
| 1255956777 | Modern Pain Consultants | Anesthesiology | 1890 Silver Cross Blvd Ste 315, New Lenox, IL 60451-9605 | 2020-06-10 |
| 1144844036 | Interventional Pain Medicine of Chicago Sc | Anesthesiology | 4433 W Touhy Ave Ste 235, Lincolnwood, IL 60712-1830 | 2020-06-05 |
| 1720627862 | Mm Infusions LLC | Anesthesiology | 1605 S Michigan Ave Unit 1, Chicago, IL 60616-1209 | 2020-01-06 |
| 1538719778 | Cpc Surgical Suite LLC | Anesthesiology | 555 W Court St Ste 100, Kankakee, IL 60901-3673 | 2019-09-19 |
| 1659854008 | Rich Noren LLC | Anesthesiology | 9000 Waukegan Rd Ste 12, Morton Grove, IL 60053-2127 | 2018-09-12 |
| 1003336470 | Vertex Anesthesia LLC | Anesthesiology | 10 Orland Square Dr # 10-c, Orland Park, IL 60462-3207 | 2017-06-26 |
| 1306386644 | Advanced Pain and Anesthesia Consultants,pc | Anesthesiology | 5215 N California Ave Ste F715, Chicago, IL 60625-7014 | 2017-03-06 |
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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.