St. John River District Hospital - Anesthesia – Certified Registered Nurse Anesthetist, NPI 1225102569
Certified Registered Nurse Anesthetist
Main info
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for St. John River District Hospital - Anesthesia
2922 SOLUTION CENTER
CHICAGO, IL 606770001
Phone: (248) 680-8000
Fax: (248) 292-3852
Type: Mailing
28000 DEQUINDRE RD
WARREN, MI 480922468
Phone: (248) 680-8000
Fax: (248) 292-3852
Type: Mailing
PO BOX 670884
DETROIT, MI 482670884
Phone: (313) 874-4806
Type: Mailing
Ascension River District Hospital, 4100, River Road, Hawthorne, SaintClair, East China Township, Saint Clair County, Michigan, 48054, United States
EAST CHINA, MI 480542909
Phone: (810) 326-2024
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2004-03-11
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20040311001049 | O | Clinic/Group Practice | MI | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60677)
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