Individual provider Active NPI

Thomas B Moffat, CRNA

  • Certified Registered Nurse Anesthetist
  • Saint Paul, MN
National Provider Identifier
1386749919
Registry record updated Oct 5, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R1431611 Issued in MN
Practice address
69 Exchange St W
Saint Paul, MN 55102-1004
Phone
(651) 735-0501
Fax
(651) 735-1870
NPI assigned
Sep 14, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2010

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 R1431611 MN Primary

Addresses

Primary practice location

69 Exchange St W
Saint Paul, MN 55102-1004

Mailing address

8681 Eagle Point Blvd
Lake Elmo, MN 55042-8628
Phone (651) 251-8021

Other identifiers 1

IdentifierTypeStateIssuer
415968300MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101129000925 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 9931395233 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
University Anesthesia Providers LLCGroup PAC ID 7315986064, 325 clinicians
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians

Practice addresses (Care Compare)

1575 Beam Ave
Maplewood, MN 55109-1126
Phone (651) 232-7000

400 E 3Rd St
Duluth, MN 55805-1951
Phone (218) 786-8364

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R1431611MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
University Anesthesia Providers, LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2024 Accepting new patients
The Duluth Clinic, LTD. CurrentSince Jan 2, 2026 Accepting new patients
The Duluth Clinic, LTD Nurse Anesthetist, Certified Registered CurrentSince Jan 2, 2026 Accepting new patients
Metropolitan Anesthesia Network, LLP Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2019 Accepting new patients

Locations

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

2020 E 28th St
Ste 100
Minneapolis, MN 55407
Phone (612) 455-0612

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

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

6401 France Ave S
Minneapolis, MN 55435
Phone (952) 920-8477

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

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

69 Exchange St W
Saint Paul, MN 55102
Phone (651) 232-1100

333 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-8256

1101 9th St N
Virginia, MN 55792
Phone (218) 305-0000

Organizations & group practices 5

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 3

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": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286236800000",
    "number": "1386749919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8681 EAGLE POINT BLVD",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550428628",
            "telephone_number": "651-251-8021",
            "fax_number": "651-251-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 EXCHANGE ST W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551021004",
            "telephone_number": "651-735-0501",
            "fax_number": "651-735-1870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOFFAT",
        "first_name": "THOMAS",
        "middle_name": "B",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2010-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R1431611",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "415968300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; 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.