Active NPI
Cassandra Tiedtke, CRNA
- Certified Registered Nurse Anesthetist
- Minneapolis, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- 1859
- Practice address
- 2450 Riverside Ave
Minneapolis, MN 55454-1450 - Phone
- (612) 672-6000
- NPI assigned
- Oct 3, 2015
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse First Assistant | 163WR0006X | R 199671-5 | MN | |
| Certified Registered Nurse Anesthetist | 367500000X | 1859 | MN | Primary |
Addresses
Primary practice location
2450 Riverside Ave
Minneapolis, MN 55454-1450
Mailing address
2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone (612) 672-6000
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, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1700 St Francis Ave
Suite 100
Shakopee, MN 55379-5582
Phone (952) 993-7800
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone (952) 993-5000
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R 199671-5 | MN | MD | Registered Nurse First Assistant |
| 1859 | MN | MD | Athletic Trainer |
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 |
| St Francis Ambulatory Services LLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
Locations
14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779
1700 Saint Francis Ave
Ste 100
Shakopee, MN 55379
Phone (952) 993-7800
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.
-
dba Park Nicollet Methodist Hospital CRNAs
- Certified Registered Nurse Anesthetist
- St Louis Park, MN
- NPI 1083622047
Nurse Anesthetist, Certified Registered
-
dba St Francis Surgery and Endoscopy Center CRNA
- Certified Registered Nurse Anesthetist
- Shakopee, MN
- NPI 1083442602
Nurse Anesthetist, Certified Registered
-
dba Park Nicollet Same Day Surgery Center
- 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
-
dba Park Nicollet Methodist Hospital Outpatient Surgery Center
- General Acute Care Hospital
- St Louis Park, MN
- NPI 1194113217
-
dba PN Methodist Hospital Episodic Bundle
- General Acute Care Hospital
- St Louis Park, MN
- NPI 1245615772
-
dba Park Nicollet Melrose Center
- Mental Illness Community Based Residential Treatment Facility
- St Louis Park, MN
- NPI 1578717336
Hospital
-
- General Acute Care Hospital
- St Louis Park, MN
- NPI 1649220724
-
dba Park Nicollet Melrose Center
- 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": "1443830400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1538524800000",
"number": "1194195156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2450 RIVERSIDE AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554541450",
"telephone_number": "612-672-6000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2450 RIVERSIDE AVE",
"city": "MINNEAPOLIS",
"state": "MN",
"postal_code": "554541450",
"telephone_number": "612-672-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TIEDTKE",
"first_name": "CASSANDRA",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-10-03",
"last_updated": "2018-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "163WR0006X",
"taxonomy_group": "",
"desc": "Registered Nurse, Registered Nurse First Assistant",
"state": "MN",
"license": "R 199671-5",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MN",
"license": "1859",
"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 Oct 3, 2018; 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.