NPIMap

Individual provider Active NPI

Zachary Dylan Blackstun

  • Anesthesiology Physician
  • Plymouth, MN
National Provider Identifier
1245891175
Registry record updated Jul 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
73539 Issued in MN
Practice address
14700 28TH Ave N Ste 20
Plymouth, MN 55447-4876
Phone
(763) 559-7779
Fax
(763) 450-3986
NPI assigned
Jun 21, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 73539 MN Primary

Addresses

Primary practice location

14700 28TH Ave N Ste 20
Plymouth, MN 55447-4876

Mailing address

PO Box 47159
Plymouth, MN 55447-0159
Phone (763) 559-3770

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230725002391 MN Practitioner - Anesthesiology 4385978873 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Creighton University School of Medicine, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Metropolitan Anesthesia Network LLPGroup PAC ID 5698689123, 516 clinicians

Practice addresses (Care Compare)

333 Smith Ave N
Saint Paul, MN 55102-2344
Phone (651) 241-8000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Metropolitan Anesthesia Network, LLP Anesthesiology CurrentSince Jul 1, 2023 Accepting new patients
University Anesthesia Providers, LLC Anesthesiology CurrentSince Oct 21, 2024 Accepting new patients

Locations

4050 Coon Rapids Blvd NW
Minneapolis, MN 55433
Phone (763) 236-6786

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779

333 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-8256

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

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.

Hospital & facility affiliations 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1561075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688515200000",
    "number": "1245891175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 47159",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554470159",
            "telephone_number": "763-559-3770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14700 28TH AVE N STE 20",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554474876",
            "telephone_number": "763-559-7779",
            "fax_number": "763-450-3986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKSTUN",
        "first_name": "ZACHARY",
        "middle_name": "DYLAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-21",
        "last_updated": "2023-07-05",
        "certification_date": "2023-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MN",
            "license": "73539",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

Verify at the official NPI Registry.