NPIMap

Individual provider Active NPI

Jill Kathleen Payne, CRNA

  • Certified Registered Nurse Anesthetist
  • Edina, MN
National Provider Identifier
1295010817
Registry record updated Oct 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R 169601-5 Issued in MN
Practice address
6401 France Ave S
Edina, MN 55435-2104
Phone
(952) 924-5185
NPI assigned
Oct 14, 2011
Last updated
Oct 14, 2011By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R 169601-5 MN Primary

Addresses

Primary practice location

6401 France Ave S
Edina, MN 55435-2104

Mailing address

21282 Inspiration CT
Lakeville, MN 55044-6027
Phone (507) 398-4791

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120105000675 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 7012183445 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2011
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

4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522
Phone (763) 236-6786

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
484MNMDMarriage & Family Therapist
R 169601-5MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Metropolitan Anesthesia Network, LLP Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2019 Accepting new patients
Fairview Past Accepting new patients

Locations

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

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

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1318550400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318550400000",
    "number": "1295010817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21282 INSPIRATION CT",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550446027",
            "telephone_number": "507-398-4791"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6401 FRANCE AVE S",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554352104",
            "telephone_number": "952-924-5185"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAYNE",
        "first_name": "JILL",
        "middle_name": "KATHLEEN",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-10-14",
        "last_updated": "2011-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R 169601-5",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Edina, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; 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.