NPIMap

Individual provider Active NPI

Kacie Nicole Wottreng, CRNA

  • Certified Registered Nurse Anesthetist
  • Minneapolis, MN
National Provider Identifier
1093095283
Registry record updated Aug 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R170181-6 Issued in MN
Practice address
2828 Chicago Ave
Suite 300
Minneapolis, MN 55407-1544
Phone
(612) 871-7639
Fax
(612) 872-0302
NPI assigned
Aug 19, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R170181-6 MN Primary

Addresses

Primary practice location

2828 Chicago Ave
Suite 300
Minneapolis, MN 55407-1544

Mailing address

2828 Chicago Ave
Suite 300
Minneapolis, MN 55407-1544
Phone (612) 871-7639

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20111216000354 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 9830364009 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Josephs Medical CenterGroup PAC ID 8224948443, 238 clinicians

Practice addresses (Care Compare)

523 N 3Rd St
Brainerd, MN 56401-3054
Phone (218) 828-7394

Hospital & facility affiliations

  • Essentia Health St Joseph'S Medical Center Hospital, Brainerd, MN, CCN 240075

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R170181-6MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Brainerd Lakes Surgery Center L L C CurrentSince Aug 1, 2013 Accepting new patients
St. Joseph'S Medical Center CurrentSince Aug 1, 2013 Accepting new patients
St Joseph'S Medical Center CurrentSince Aug 1, 2013 Accepting new patients
St. Joseph'S Medical Center Current Accepting new patients
Regional Anesthesia Services PA CurrentSince Dec 23, 2020 Accepting new patients
Northwest Anesthesia, P.a. Past Accepting new patients
Northwest Anesthesia P.a. Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

13114 Isle Dr
Baxter, MN 56425
Phone (218) 822-2400

523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394

523 N 3rd St
Ofc
Brainerd, MN 56401
Phone (218) 828-2880

13911 Ridgedale Dr
Ste 404B
Minnetonka, MN 55305
Phone (612) 636-0061

Organizations & group practices 7

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

Hospital & facility affiliations 10

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1313712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1313712000000",
    "number": "1093095283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2828 CHICAGO AVE",
            "address_2": "SUITE 300",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071544",
            "telephone_number": "612-871-7639",
            "fax_number": "612-872-0302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2828 CHICAGO AVE",
            "address_2": "SUITE 300",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071544",
            "telephone_number": "612-871-7639",
            "fax_number": "612-872-0302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOTTRENG",
        "first_name": "KACIE",
        "middle_name": "NICOLE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-19",
        "last_updated": "2011-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R170181-6",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.