OrganizationActive
St. Mary'S Hospital, Centralia, Illinois
NPI 1477097871 · Anesthesiology Physician · Centralia, IL
Provider details
- NPI number
- 1477097871
- Entity type
- Organization
- Primary specialty
- Anesthesiology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Tim Buller, Regional Cfo(314) 989-2492
- License
- 0002642 (IL)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Allopathic & Osteopathic Physicians
Profile Score
Established profile(71/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
9 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
400 N Pleasant Ave
Centralia, IL 62801-3056
Phone: (618) 436-6056
Fax: (618) 532-9365
Street-level locationGet directions
Mailing address
1145 Corporate Lake Dr
Saint Louis, MO 63132-2907
Other names (DBA / former)
- Doing business as
- Ssm Health St. Mary'S Hospital - Centralia
Registry dates
- Enumerated
- 2016-12-05
- Last updated
- 2018-03-26
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.