MEDICARE: JAMES M. PERKINS CRNA

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	041-338406	IL
2	367500000X	Certified Registered Nurse Anesthetist	8931-33	WI

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DE1450	OTHER	IL	MEDICARE RAILROAD GROUP PTAN
2	P00603701	OTHER	IL	MEDICARE RAILROAD GROUP MEMBER PTAN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1205005113
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES M. PERKINS CRNA

Provider Business Mailing Address
First Line	:	800 E CARPENTER ST RM 2K64
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62769-0001
Country	:	US
Telephone Number	:	217-525-5643
Fax Number	:	217-544-2521

Provider Business Practice Location Address
First Line	:	800 E CARPENTER ST
Second Line	:	ROOM 2K64
City	:	SPRINGFIELD
State	:	IL
Zip	:	62769-0002
Country	:	US
Telephone Number	:	217-525-5643
Fax Number	:	217-544-2521

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2008
Last Update Date	:	02/04/2026

2101 E JEFFERSON ST , KAISER PERMANENTE SPRINGFIELD MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 701-922-1000
Practice Fax: 703-922-1039