Active NPI
Mark O'Brien
- Certified Registered Nurse Anesthetist
- Plymouth, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 238058-2
- Practice address
- 11505 39TH Ave N
Plymouth, MN 55441-1310 - Phone
- (612) 751-7531
- NPI assigned
- Aug 31, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 238058-2 | MN | |
| Certified Registered Nurse Anesthetist | 367500000X | 238058-2 | MN | Primary |
Addresses
Primary practice location
11505 39TH Ave N
Plymouth, MN 55441-1310
Mailing address
11505 39TH Ave N
Plymouth, MN 55441-1310
Phone (612) 751-7531
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL, MN
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-5000
Hospital & facility affiliations
- Park Nicollet Methodist Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 238058-2 | MN | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Park Nicollet Methodist Hospital | Current | Accepting new patients | |
| Park Nicollet Methodist Hospital | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Northstar Anesthesia of Illinois, LLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
Locations
13500 Powers Ct
Ste 230
Fort Myers, FL 33912
Phone (239) 610-0784
1423 Chicago Rd
Sauk Village, IL 60411
Phone (708) 679-2160
14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779
6500 Excelsior Blvd
St Louis Park, MN 55426
Phone (952) 993-3246
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 and National Provider Directory roles.
-
- Certified Registered Nurse Anesthetist
- St Louis Park, MN
- NPI 1083622047
Nurse Anesthetist, Certified Registered
-
- Anesthesiology Physician
- Arlington, TX
- NPI 1962822395
IL, Nurse Anesthetist, Certified Registered
-
- Ambulatory Surgical Clinic/Center
- Burnsville, MN
- NPI 1649827973
Hospital & facility affiliations 6
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Maple Grove, MN
- NPI 1174980692
-
- General Acute Care Hospital
- St Louis Park, MN
- NPI 1194113217
-
- General Acute Care Hospital
- St Louis Park, MN
- NPI 1245615772
-
- Mental Illness Community Based Residential Treatment Facility
- St Louis Park, MN
- NPI 1578717336
Hospital
-
- General Acute Care Hospital
- St Louis Park, MN
- NPI 1649220724
-
- General Acute Care Hospital
- St Louis Park, MN
- NPI 1942585286
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1702339200000",
"number": "1124796545",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11505 39TH AVE N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554411310",
"telephone_number": "612-751-7531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11505 39TH AVE N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554411310",
"telephone_number": "612-751-7531"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'BRIEN",
"first_name": "MARK",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-08-31",
"last_updated": "2023-12-12",
"certification_date": "2023-12-12",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MN",
"license": "238058-2",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MN",
"license": "238058-2",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2023; 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.