Individual provider Active NPI

Elizabeth Cleary Kingstedt, CRNA

  • Certified Registered Nurse Anesthetist
  • Champlin, MN
National Provider Identifier
1356744882
Registry record updated Dec 12, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R 206981-6 Issued in MN
Practice address
11416 Yates Ave N
Champlin, MN 55316-2908
Phone
(360) 356-2730
NPI assigned
Sep 29, 2014
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 12, 2014

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 206981-6 MN Primary

Addresses

Primary practice location

11416 Yates Ave N
Champlin, MN 55316-2908

Mailing address

11416 Yates Ave N
Champlin, MN 55316-2908
Phone (612) 360-9484

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200728001156 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 9335563071 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Minnesota Anesthesia Specialists PLLCGroup PAC ID 8426423039, 8 clinicians

Practice addresses (Care Compare)

1447 White Oak Dr
Chaska, MN 55318-2525
Phone (952) 368-3800

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1004MNMDAcupuncturist
R 206981-6MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesiology, P.a. Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2020 Accepting new patients
Minnesota Anesthesia Specialists PLLC CurrentSince Sep 11, 2023 Accepting new patients
Metropolitan Anesthesia Network, LLP Nurse Anesthetist, Certified Registered CurrentSince Mar 30, 2020 Accepting new patients

Locations

1447 White Oak Dr
Chaska, MN 55318
Phone (952) 368-3800

9875 Hospital Dr
Maple Grove, MN 55369
Phone (763) 581-1000

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

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

3300 Oakdale Ave N
Robbinsdale, MN 55422
Phone (763) 520-5048

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1411948800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418342400000",
    "number": "1356744882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11416 YATES AVE N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553162908",
            "telephone_number": "612-360-9484"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11416 YATES AVE N",
            "city": "CHAMPLIN",
            "state": "MN",
            "postal_code": "553162908",
            "telephone_number": "360-356-2730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KINGSTEDT",
        "first_name": "ELIZABETH",
        "middle_name": "CLEARY",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-29",
        "last_updated": "2014-12-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R 206981-6",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Champlin, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2014; 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.