Active NPI
Jessica L Khan, CRNA
- Certified Registered Nurse Anesthetist
- Eagan, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- R 160103-9
- Practice address
- 2620 Eagan Woods Dr Ste 300
Eagan, MN 55121-1138 - Phone
- (651) 968-5240
- NPI assigned
- Apr 23, 2008
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | R 160103-9 | MN | Primary |
Addresses
Primary practice location
2620 Eagan Woods Dr Ste 300
Eagan, MN 55121-1138
Mailing address
2620 Eagan Woods Dr Ste 300
Eagan, MN 55121-1138
Phone (651) 968-5240
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ENROLLED | Medicaid | MN |
Other names 1
- Jessica L Sticka
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2008
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
201 E Nicollet Blvd
Burnsville, MN 55337-5714
Phone (952) 892-2000
2620 Eagan Woods Dr
Suite 300
Eagan, MN 55121-1138
Phone (651) 968-5215
Hospital & facility affiliations
- M Health Fairview Ridges Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R 160103-9 | MN | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| South Metropolitan Anesthesia, PA | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Metropolitan Anesthesia Network, LLP | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
Locations
201 E Nicollet Blvd
Burnsville, MN 55337
Phone (952) 892-2000
2620 Eagan Woods Dr
Ste 300
Eagan, MN 55121
Phone (651) 968-5215
4050 Coon Rapids Blvd NW
Minneapolis, MN 55433
Phone (763) 236-6786
14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779
400 10th St E
Waconia, MN 55387
Organizations & group practices 2
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.
-
- Anesthesiology Physician
- Plymouth, MN
- NPI 1558314427
Nurse Anesthetist, Certified Registered
-
- Certified Registered Nurse Anesthetist
- Burnsville, MN
- NPI 1649265737
Nurse Anesthetist, Certified Registered
Hospital & facility affiliations 2
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Burnsville, MN
- NPI 1225199128
-
- General Acute Care Hospital
- Burnsville, MN
- NPI 1245217520
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1208908800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566518400000",
"number": "1124293915",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2620 EAGAN WOODS DR STE 300",
"city": "EAGAN",
"state": "MN",
"postal_code": "551211138",
"telephone_number": "651-968-5240"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2620 EAGAN WOODS DR STE 300",
"city": "EAGAN",
"state": "MN",
"postal_code": "551211138",
"telephone_number": "651-968-5240"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KHAN",
"first_name": "JESSICA",
"middle_name": "L",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2008-04-23",
"last_updated": "2019-08-23",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MN",
"license": "R 160103-9",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "ENROLLED",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "STICKA",
"middle_name": "L",
"credential": "CRNA",
"code": "1",
"type": "Former Name"
}
]
}
Other providers in Eagan, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2019; 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.