NPIMap

Individual provider Active NPI

Stacy Ann Cederstrom, FNP

  • Family Nurse Practitioner
  • Cass Lake, MN
National Provider Identifier
1174079917
Registry record updated May 22, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
CNP4566 Issued in MN
Practice address
425 7TH Street North East
Cass Lake, MN 56633
Phone
(218) 335-3200
Fax
(218) 335-3300
NPI assigned
Aug 31, 2016
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 22, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 4566 MN
Family Nurse Practitioner 363LF0000X CNP4566 MN Primary

Addresses

Primary practice location

425 7TH Street North East
Cass Lake, MN 56633

Mailing address

425 7TH Street North East
Cass Lake, MN 56633
Phone (218) 335-3200

Other practice location 1

1120 E 34th St
Hibbing, MN 55746-2909
Phone (218) 362-7100

Other identifiers 2

IdentifierTypeStateIssuer
CNP4566OtherMNFNP LICENSE
MC3911028OtherMNDNP

Other names 1

  • Stacy Ann Tandeski Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX, MN2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20170315000559 TX Practitioner - Nurse Practitioner 2365727336 Reassigns benefits to 1 organization
I20170531001596 MN Practitioner - Nurse Practitioner 2365727336 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1611 Anne St NW
Bemidji, MN 56601-5114
Phone (218) 333-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
CNP4566MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Health of Northern Minnesota CurrentSince Nov 18, 2024 Accepting new patients
St. Luke's Hospital of Duluth CurrentSince Mar 8, 2019 Accepting new patients
St. Luke's Hospital of Duluth CurrentSince Mar 8, 2019 Accepting new patients
St Joseph's Area Health Services CurrentSince Apr 22, 2017 Accepting new patients
Sanford Health of Northern Minnesota Current Accepting new patients
Sanford Health Network North Current Accepting new patients
Sanford Health Network North CurrentSince Apr 22, 2023 Accepting new patients
St. Luke's Hospital of Duluth Current Accepting new patients
Sanford Health Network North Current Accepting new patients
Sanford Health Network North CurrentSince Apr 22, 2023 Accepting new patients
Department of Health & Human Services PHS IHS CurrentSince Jan 29, 2017 Accepting new patients
St. Joseph's Area Health Services Current Accepting new patients
St Josephs Community Dental Clinic Past Accepting new patients
St. Luke's Hospital of Duluth Past Accepting new patients

Locations

3314 Solutions Ctr
Chicago, IL 60677

29980 Network Pl
Chicago, IL 60673

350 E Devon Ave
Itasca, IL 60143

1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020

425 7th St NW
Cass Lake, MN 56633
Phone (218) 335-3200

1015 E 1st St
Duluth, MN 55805
Phone (218) 249-7860

1120 E 34th St
Hibbing, MN 55746
Phone (218) 263-7455

600 Pleasant Ave S
Park Rapids, MN 56470
Phone (218) 732-3311

1720 US Highway 59 SE
Thief Rvr Fls, MN 56701
Phone (218) 681-4747

8373 Unity Dr
Virginia, MN 55792
Phone (218) 748-7421

4784 Amber Valley Pkwy S
Fargo, ND 58104

Organizations & group practices 14

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.

View all 14

Hospital & facility affiliations 6

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": "1472601600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684713600000",
    "number": "1174079917",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "425 7TH STREET NORTH EAST",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "56633",
            "telephone_number": "218-335-3200",
            "fax_number": "218-335-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "425 7TH STREET NORTH EAST",
            "city": "CASS LAKE",
            "state": "MN",
            "postal_code": "56633",
            "telephone_number": "218-335-3200",
            "fax_number": "218-335-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1120 E 34th St",
            "address_purpose": "LOCATION",
            "city": "Hibbing",
            "state": "MN",
            "postal_code": "557462909",
            "country_code": "US",
            "telephone_number": "218-362-7100",
            "fax_number": "218-362-7131",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CEDERSTROM",
        "first_name": "STACY",
        "middle_name": "ANN",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-08-31",
        "last_updated": "2023-05-22",
        "certification_date": "2023-05-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MN",
            "license": "4566",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "CNP4566",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FNP LICENSE",
            "identifier": "CNP4566",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DNP",
            "identifier": "MC3911028",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "STACY",
            "last_name": "TANDESKI",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cass Lake, MN

Sources for this page

Verify at the official NPI Registry.