Clark J Kruta, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

R21653 Issued in ND

Practice address

570 Chautauqua Blvd
Valley City, ND 58072-3145

Phone

(701) 845-6522

Fax

(701) 845-6520

NPI assigned

Jun 23, 2006

Last updated

Apr 10, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 1992

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mercy Hospital of Valley CityGroup PAC ID 8729997564, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• CHI Mercy Health Hospital, Valley City, ND, CCN 351324

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Mercy Hospital of Valley City

  dba CHI Mercy Health

  • Critical Access Hospital
  • Valley City, ND
  • NPI 1477549111
  Medicare reassignment Care Compare group NPD
• Lisbon Area Health Services

  dba CHI Lisbon Health

  • Clinic/Center
  • Lisbon, ND
  • NPI 1811168958
  Medicare reassignment NPD
• Lisbon Area Health Services

  dba CHI Lisbon Health

  • Clinic/Center
  • Lisbon, ND
  • NPI 1184051971
  NPD
• Mercy Hospital

  dba HiLine Medical Equipment

  • Durable Medical Equipment & Medical Supplies
  • Valley City, ND
  • NPI 1457313819
  NPD
• Mercy Hospital of Valley City

  dba CHI Mercy Health

  • Clinic/Center
  • Valley City, ND
  • NPI 1972698975
  NPD
• Lisbon Area Health Services

  dba CHI Lisbon Health

  • Medicare Defined Swing Bed Hospital Unit
  • Lisbon, ND
  • NPI 1033292875
  NPD (past)
• Mercy Hospital of Devils Lake

  dba CHI St Alexius Health Devils Lake

  • Critical Access Hospital
  • Devils Lake, ND
  • NPI 1659343093
  NPD (past)

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

• Mercy Hospital of Valley City

  dba CHI Mercy Health

  • Critical Access Hospital
  • Valley City, ND
  • NPI 1477549111
  Care Compare affiliation

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1523318400000",
    "number": "1205862273",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "251 4TH AVE NW",
            "city": "VALLEY CITY",
            "state": "ND",
            "postal_code": "580722931",
            "telephone_number": "701-845-9399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "570 CHAUTAUQUA BLVD",
            "city": "VALLEY CITY",
            "state": "ND",
            "postal_code": "580723145",
            "telephone_number": "701-845-6522",
            "fax_number": "701-845-6520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUTA",
        "first_name": "CLARK",
        "middle_name": "J",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2018-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ND",
            "license": "R21653",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1454945",
            "state": "ND"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "R21653",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kari Marie Kietzman, CNP
• Krista Thielges Kjelland, PA-C
• Mark W Klabo, PA-C
• Nicole Klefstad Johnson
• Kathryn Kohler, DNP, FNP-C
• Tessa Lagein
• Kelsie Lynn Laizure
• Laura M Lassiter, D.C.
• Kaitlen Karolina Lee, REGISTERED NURSE
• Silvon Lee

• Certified Registered Nurse Anesthetist in Valley City, ND
• Providers in Valley City, ND by specialty
• Certified Registered Nurse Anesthetist in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 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.

Verify at the official NPI Registry.