PRAIRIELAND OUTPATIENT DIAGNOSTIC CENTER, LLC (NPI# 1700252228) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700252228 |
| Entity Type | Organization |
| Organization Name | PRAIRIELAND OUTPATIENT DIAGNOSTIC CENTER, LLC |
| Other Organization Name | DIGESTIVE DISEASE ENDOSCOPY CENTER |
| Practice Address |
1302 Franklin Ave Suite 1000 Normal IL 61761-3551 |
| Practice Telephone | 3092683400 |
| Practice Fax Number | 3092683423 |
| Mailing Telephone | 3092683400 |
| Mailing Fax Number | 3092683423 |
| Enumeration Date | 2015-08-19 |
| Last Update Date | 2020-01-16 |
| Authorized Official Name | SHARON M HOHLFELD (CO-TREASURER) |
| Authorized Official Telephone | 2155899024 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207L00000X | Anesthesiology | Allopathic & Osteopathic Physicians | ||
| Y | 367500000X | Nurse Anesthetist, Certified Registered | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Digestive Disease Endoscopy Center | Doing Business As Name - Organization |
| Street Address |
1302 FRANKLIN AVE SUITE 1000 |
| City | NORMAL |
| State | IL |
| Zip Code | 61761-3551 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063419679 | John D Fulk | Physician Assistant | 1302 Franklin Ave, Suite 4800, Normal, IL 61761-3551 | 2005-06-29 |
| 1235686759 | Brooke Davis | Nurse Practitioner | 1302 Franklin Ave, Suite 4800, Normal, IL 61761-3551 | 2016-09-01 |
| 1043676109 | Amy J Stites | Physician Assistant | 1302 Franklin Ave, Suite 4800, Normal, IL 61761-3551 | 2016-01-05 |
| 1255700316 | Abigail G Cervantes | Obstetrics & Gynecology | 1302 Franklin Ave, Suite 2800, Normal, IL 61761-6526 | 2015-09-18 |
| 1467860445 | Christie Rocke | Nurse Practitioner | 1302 Franklin Ave, Suite 3400, Normal, IL 61761-3551 | 2014-07-23 |
| 1114343225 | Jennifer Lanz | Nurse Practitioner | 1302 Franklin Ave, Suite 4500, Normal, IL 61761-3551 | 2014-03-13 |
| 1396189411 | Consulting Anesthesiologists LLC | Anesthesiology | 1302 Franklin Ave, Normal, IL 61761-3551 | 2013-04-19 |
| 1285903799 | Bromenn Physicians Management Corporation | Counselor | 1302 Franklin Ave, Suite 1100, Normal, IL 61761-3551 | 2011-12-29 |
| 1922377431 | Bromenn Physicians Management Corporation | Internal Medicine | 1302 Franklin Ave, Suite 4500, Normal, IL 61761-3551 | 2011-12-29 |
| 1033494455 | Maneesha T Joseph | Registered Nurse | 1302 Franklin Ave, Suite 3400, Normal, IL 61761-3551 | 2011-10-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629681796 | Brittany Nicole Mekley | Nurse Practitioner | 201 N. University, Normal, IL 61761 | 2020-08-28 |
| 1679108971 | Krystal Halliday | Occupational Therapist | 1815 N Towanda Barnes Rd, Normal, IL 61761 | 2020-03-06 |
| 1265915474 | Laine E Burek | Nurse Practitioner | 1765 Bradford Ln., Normal, IL 61761 | 2018-09-13 |
| 1801389986 | Ashley Michelle James | Specialist/Technologist | 347 S. University St, Normal, IL 61761 | 2018-06-12 |
| 1447750708 | Shelley R. Ruch | Specialist/Technologist, Other | 1604 Visa Drive, Ste 1, Normal, IL 61761 | 2018-02-13 |
| 1497275069 | Mclean County Nursing Home | Non-emergency Medical Transport (VAN) | 901 N. Main St, Normal, IL 61761 | 2017-06-23 |
| 1235673666 | Megan Threm | Registered Nurse | 900 Franklin Ave Community Health Care Clinic, Normal, IL 61761 | 2016-12-04 |
| 1437513553 | Tiesha Smith | Specialist | 1800 Rockingham Dr, Apt 1d, Normal, IL 61761 | 2016-04-06 |
| 1285031658 | New Day Recovery | Community/Behavioral Health | 402 Summit, Normal, IL 61761 | 2014-12-01 |
| 1174927701 | Alyssa Marie Bruck | Occupational Therapist | 700 N Walnut St, Normal, IL 61761 | 2014-10-10 |
| Find all providers in zip 61761 | ||||
| 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 |
|---|---|---|---|---|
| 1396161063 | Nicole Christine Schertz | Nurse Anesthetist, Certified Registered | 1304 Franklin Ave, Normal, IL 61761-3558 | 2014-03-05 |
| 1083043483 | Dodi Suhari | Nurse Anesthetist, Certified Registered | 1304 Franklin Ave, Normal, IL 61761 | 2013-11-06 |
| 1255672069 | Marcia Robinson | Nurse Anesthetist, Certified Registered | 1304 Franklin Ave, Normal, IL 61761-3558 | 2013-03-05 |
| 1043551856 | Ann Schoen | Nurse Anesthetist, Certified Registered | 1304 Franklin Ave, Normal, IL 61761-3558 | 2013-03-05 |
| 1366791774 | Carrie S. Garrett | Nurse Anesthetist, Certified Registered | 1304 Franklin Ave, Normal, IL 61761-3558 | 2012-08-30 |
| 1538452602 | Sarah Anne Cary Welsh | Nurse Anesthetist, Certified Registered | 1304 Franklin Ave, Normal, IL 61761-3558 | 2011-05-24 |
| 1346551702 | Mary Elizabeth Starnes | Nurse Anesthetist, Certified Registered | 1304 Franklin Ave, Normal, IL 61761-3558 | 2010-06-30 |
| 1497894489 | Andrea Lasser | Nurse Anesthetist, Certified Registered | 1300 Franklin Ave, Normal, IL 61761-3592 | 2007-02-06 |
| 1194756940 | Angela Brown | Nurse Anesthetist, Certified Registered | 2200 Fort Jesse Rd, Suite 240, Normal, IL 61761-6286 | 2006-07-06 |
| 1346282522 | Anesthesiology Consultants Ltd | Nurse Anesthetist, Certified Registered | 1302 Franklin Ave, Normal, IL 61761-3551 | 2006-06-12 |
| Find all providers in NORMAL | ||||
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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.