Individual provider Active NPI

Melissa Marie Lake, CRNA

  • Certified Registered Nurse Anesthetist
  • St Louis Park, MN
National Provider Identifier
1275961682
Registry record updated Sep 27, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
7365 Issued in NC
Practice address
6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone
(952) 993-5222
NPI assigned
Oct 22, 2013
Last updated
Sep 27, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 27, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 198 MN
Certified Registered Nurse Anesthetist 367500000X 7365 NC Primary

Addresses

Primary practice location

6500 Excelsior Blvd
St Louis Park, MN 55426-4702

Mailing address

6055 Westbrook Rd
Golden Valley, MN 55422-3335
Phone (773) 469-1872

Other practice location 1

800 E 28th St
Minneapolis, MN 55407-3723
Phone (612) 863-4000

Other practice location 2

2855 Campus Dr
Plymouth, MN 55441-2649
Phone (763) 577-7240

Other names 1

  • Ms. Melissa Marie Powers Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, NC2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140106001410 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 5991933541 Reassigns benefits to 2 organizations
I20241025001043 NC Practitioner - Certified Registered Nurse Anesthetist (Crna) 5991933541 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

2131 S 17TH St
Wilmington, NC 28401-7407
Phone (910) 343-7044

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
92.66 of 100Reported as group
Quality
79.17
Promoting interoperability
100
Improvement activities
40
Cost
73.43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
7365NCMDOccupational Therapy Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Pender Memorial Hospital Incorporated Current Accepting new patients
Pender Memorial Hospital, Incorporated CurrentSince Sep 9, 2024 Accepting new patients
Metropolitan Anesthesia Network, LLP Nurse Anesthetist, Certified Registered CurrentSince Feb 3, 2020 Accepting new patients
Novant Health New Hanover Regional Medical Center LLC Nurse Anesthetist, Certified Registered CurrentSince Sep 9, 2024 Accepting new patients
Novant Health New Hanover Regional Medical Center LLC CurrentSince Sep 9, 2024 Accepting new patients

Locations

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

800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547

8100 W 78th St
Ste 220
Minneapolis, MN 55439
Phone (952) 914-8400

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

2855 Campus Dr
Plymouth, MN 55441
Phone (763) 577-7000

2855 Campus Dr
Ste 200
Plymouth, MN 55441
Phone (763) 302-2800

6500 Excelsior Blvd
St Louis Park, MN 55426
Phone (952) 993-3246

507 E Fremont St
Burgaw, NC 28425
Phone (910) 259-5451

105 Scotts Hill Medical Dr
Wilmington, NC 28411
Phone (910) 686-2840

2131 S 17th St
Wilmington, NC 28401
Phone (910) 342-3000

Organizations & group practices 6

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.

Hospital & facility affiliations 1

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": "1382400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1727395200000",
    "number": "1275961682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6055 WESTBROOK RD",
            "city": "GOLDEN VALLEY",
            "state": "MN",
            "postal_code": "554223335",
            "telephone_number": "773-469-1872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6500 EXCELSIOR BLVD",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554264702",
            "telephone_number": "952-993-5222"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 E 28th St",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554073723",
            "country_code": "US",
            "telephone_number": "612-863-4000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2855 Campus Dr",
            "address_purpose": "LOCATION",
            "city": "Plymouth",
            "state": "MN",
            "postal_code": "554412649",
            "country_code": "US",
            "telephone_number": "763-577-7240",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAKE",
        "first_name": "MELISSA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-22",
        "last_updated": "2024-09-27",
        "certification_date": "2024-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "198",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NC",
            "license": "7365",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "POWERS",
            "middle_name": "MARIE",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in St Louis Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2024; 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.