NPIMap

Organization Active NPI

Anesthesiology, P.a.

  • Anesthesiology Physician
  • Robbinsdale, MN
National Provider Identifier
1013960798
Registry record updated Feb 9, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
68 Issued in MN
Legal business name
ANESTHESIOLOGY, P.A.
Practice address
3300 Oakdale Ave N
Robbinsdale, MN 55422-2926
Phone
(763) 520-5370
NPI assigned
May 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
John Y Hendricks, M.D.NPI 1679529846
Title
President
Phone
(763) 520-5370

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207L00000X 68 MN Primary
Certified Registered Nurse AnesthetistGroup: 193200000X MULTI-SPECIALTY GROUP 367500000X

Addresses

Primary practice location

3300 Oakdale Ave N
Robbinsdale, MN 55422-2926

Mailing address

14700 28TH Ave N
Suite 20
Plymouth, MN 55447-4876
Phone (763) 559-3779

Other identifiers 1

IdentifierTypeStateIssuer
429808000MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040212000459 MN Part B Supplier - Clinic/Group Practice 9335033034 Receives reassigned benefits from 244 practitioners
Practice locations: Maple Grove, MN; Robbinsdale, MN

National Provider Directory

National Provider Directory

Locations

9550 Upland Ln N
Ste 150
Maple Grove, MN 55369
Phone (763) 420-2981

15450 Highway 7
Ste 200
Minnetonka, MN 55345
Phone (763) 581-8950

15450 Highway 7
Ste 20
Minnetonka, MN 55345

Practitioners & affiliated clinicians

Practitioners 246

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 246

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454976000000",
    "number": "1013960798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14700 28TH AVE N",
            "address_2": "SUITE 20",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554474876",
            "telephone_number": "763-559-3779",
            "fax_number": "763-450-3986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3300 OAKDALE AVE N",
            "city": "ROBBINSDALE",
            "state": "MN",
            "postal_code": "554222926",
            "telephone_number": "763-520-5370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ANESTHESIOLOGY, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2016-02-09",
        "status": "A",
        "authorized_official_last_name": "HENDRICKS",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "Y",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-520-5370",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "MN",
            "license": "68",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "429808000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Robbinsdale, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.