Individual provider Active NPI

Chris A Rodahl

  • Anesthesiology Physician
  • Maplewood, MN
National Provider Identifier
1053423343
Registry record updated Mar 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
36407 Issued in MN
Practice address
1575 Beam Ave
Maplewood, MN 55109-1126
Phone
(651) 735-0501
Fax
(651) 735-1870
NPI assigned
Aug 31, 2006
Last updated
Mar 22, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 36407 MN Primary

Addresses

Primary practice location

1575 Beam Ave
Maplewood, MN 55109-1126

Mailing address

8681 Eagle Point Blvd
Lake Elmo, MN 55042-8628
Phone (651) 251-8021

Other identifiers 1

IdentifierTypeStateIssuer
737022900MedicaidMN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100903000502 MN Practitioner - Anesthesiology 3173647682

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
36407MNMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Health System-NR LLC CurrentSince Jun 1, 2020 Accepting new patients
Centracare Health System-NR LLC Current Accepting new patients
Associated Anesthesiologists PA Anesthesiology Past Accepting new patients

Locations

1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1269216000000",
    "number": "1053423343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8681 EAGLE POINT BLVD",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550428628",
            "telephone_number": "651-251-8021",
            "fax_number": "651-251-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1575 BEAM AVE",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091126",
            "telephone_number": "651-735-0501",
            "fax_number": "651-735-1870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RODAHL",
        "first_name": "CHRIS",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2010-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MN",
            "license": "36407",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "737022900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Maplewood, MN

Sources for this page

Verify at the official NPI Registry.