Susan A Peterson, CRNA
Individual provider Active NPI Certified Registered Nurse Anesthetist · Saint Cloud, MN
NPI 1336334663 · NPPES record last updated Apr 28, 2008
Key facts
- NPI
- 1336334663
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Certified Registered Nurse Anesthetist 367500000X
- License
- R 134635-2 (MN)
- Practice address
- 1406 6TH Ave N
Saint Cloud, MN 56303-1900 - Phone
- (320) 251-2700
- NPI assigned
- Sep 10, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 21
Hospital & facility affiliations 7
Medicare Care Compare profile
- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Allina Health System
Centracare Clinic
Practice addresses (Care Compare)
303 Catlin St
Buffalo, MN 55313-1947
3701 12TH St N
Suite 202
Saint Cloud, MN 56303-2253
Phone (320) 258-3090
Hospital & facility affiliations
- Buffalo Hospital
- Centracare - St. Cloud Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080110000572 | MN | Practitioner - Certified Registered Nurse Anesthetist (Crna) | 3779663158 | Reassigns benefits to 4 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R 134635-2 | MN | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Centracare Health System-NR LLC | Current |
Accepting new patients | |
| Allina Health System | Nurse Anesthetist, Certified Registered | Current |
Accepting new patients |
| Centracare Clinic | Current | Accepting new patients | |
| Centracare Health System-NR LLC | Current | Accepting new patients | |
| Centracare Health System-NR LLC | Current |
Accepting new patients | |
| Centracare Clinic | Current |
Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| Central Minnesota Anesthesia Providers, PLLC | Past | Accepting new patients |
Locations
303 Catlin St
Buffalo, MN 55313
Phone (763) 682-1212
2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640
1013 Hart Blvd
Monticello, MN 55362
Phone (763) 271-2303
14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779
1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342
1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422
1900 Centracare Cir
Ste 1900
Saint Cloud, MN 56303
Phone (320) 229-4964
1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657
3701 12th St N
Ste 202
Saint Cloud, MN 56303
Phone (320) 258-3090
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | R 134635-2 | MN | Yes |
Addresses
Primary practice location
1406 6TH Ave N
Saint Cloud, MN 56303-1900
Mailing address
3701 12TH St N
Ste 202
Saint Cloud, MN 56303-2255
Phone (320) 258-3090
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 078417000 | Medicaid | MN |
Other providers in Saint Cloud, MN
- Nicole E Peterson
- Paul Charles Peterson
- Richard Allen Peterson
- Russell Thomas Peterson
- Shaina Peterson
- Tara Peterson
- Theodore A Peterson
- Thomas M Peterson
- Thomas Merlin Peterson
- George Petrangelo
All providers in Saint Cloud, MN · Certified Registered Nurse Anesthetist in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 28, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.