NPIMap

Individual provider Active NPI

Jenna Stark

  • Certified Registered Nurse Anesthetist
  • Minneapolis, MN
National Provider Identifier
1386009892
Registry record updated Mar 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
1866 Issued in MN
Practice address
2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone
(612) 365-1000
NPI assigned
Dec 28, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 19, 2018

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 1866 MN Primary

Addresses

Primary practice location

2450 Riverside Ave
Minneapolis, MN 55454-1450

Mailing address

18032 70TH PL N
Maple Grove, MN 55311-3032
Phone (320) 309-4780

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160429001461 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 7416256151 Reassigns benefits to 8 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Anesthesia Providers LLCGroup PAC ID 7315986064, 325 clinicians
St Josephs Medical CenterGroup PAC ID 8224948443, 238 clinicians
Anesthesiology, P.a.Group PAC ID 9335033034, 136 clinicians

Practice addresses (Care Compare)

2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone (612) 273-4097

523 N 3Rd St
Brainerd, MN 56401-3054
Phone (218) 828-7400

9875 Hospital Dr
Maple Grove, MN 55369-4648
Phone (763) 898-1000

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Healtheast Medical Research Institute Current Accepting new patients
St Joseph's Medical Center CurrentSince Jun 5, 2023 Accepting new patients
Central Minnesota Anesthesia Providers, PA Nurse Anesthetist, Certified Registered CurrentSince Feb 1, 2022 Accepting new patients
Healtheast Medical Research Institute CurrentSince May 29, 2020 Accepting new patients
Fairview Health Services CurrentSince Mar 17, 2020 Accepting new patients
Anesthesiology, P.a. Nurse Anesthetist, Certified Registered CurrentSince Aug 11, 2022 Accepting new patients
St. Joseph's Medical Center CurrentSince Jun 5, 2023 Accepting new patients
Healtheast Medical Research Institute CurrentSince May 29, 2020 Accepting new patients
Fairview Health Services Nurse Anesthetist, Certified Registered Current Accepting new patients
St. Joseph's Medical Center Current Accepting new patients
Fairview Express Care CurrentSince Mar 17, 2020 Accepting new patients
Brainerd Lakes Surgery Center L L C CurrentSince May 22, 2023 Accepting new patients
University Anesthesia Providers, LLC Nurse Anesthetist, Certified Registered CurrentSince Mar 27, 2016 Accepting new patients

Locations

13114 Isle Dr
Baxter, MN 56425
Phone (218) 822-2400

14054 Bank St
Becker, MN 55308
Phone (763) 260-8808

523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394

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

14500 99th Ave N
Ste 500
Maple Grove, MN 55369
Phone (763) 898-1400

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

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

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

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

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

1700 University Ave W
Fl 6
Saint Paul, MN 55104
Phone (651) 232-2273

45 10th St W
Saint Paul, MN 55102
Phone (651) 232-3000

Organizations & group practices 15

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.

View all 15

Hospital & facility affiliations 4

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": "1451260800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521417600000",
    "number": "1386009892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18032 70TH PL N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553113032",
            "telephone_number": "320-309-4780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-365-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STARK",
        "first_name": "JENNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-12-28",
        "last_updated": "2018-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "1866",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2018; 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.