Individual provider Active NPI

Nina Wentz, CRNA

  • Certified Registered Nurse Anesthetist
  • Fargo, ND
National Provider Identifier
1407128135
Registry record updated Sep 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R31181 Issued in ND
Practice address
801 Broadway N
Fargo, ND 58102-3641
Phone
(701) 234-5621
Fax
(701) 234-7334
NPI assigned
Jan 26, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2012

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 R31181 ND Primary

Addresses

Primary practice location

801 Broadway N
Fargo, ND 58102-3641

Mailing address

801 Broadway N
Fargo, ND 58102-3641

Other identifiers 1

IdentifierTypeStateIssuer
16728MedicaidND

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ND, MN2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20120410000490 ND Practitioner - Certified Registered Nurse Anesthetist (Crna) 1456512961 Reassigns benefits to 5 organizations
I20160316002257 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 1456512961 Reassigns benefits to 2 organizations

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
St Francis Medical CenterGroup PAC ID 8123937992, shared by 4 NPIs, 16 clinicians
Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

2400 St Francis Dr
Breckenridge, MN 56520-1025
Phone (218) 643-3000

3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R31181NDMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Cssa, LLC Nurse Anesthetist, Certified Registered CurrentSince Jun 15, 2020 Accepting new patients
St. Francis Medical Center CurrentSince Feb 26, 2016 Accepting new patients
St. Francis Medical Center CurrentSince Jan 5, 2026 Accepting new patients
Lutheran Charity Association Current Accepting new patients
Lutheran Charity Association Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2020 Accepting new patients
Lutheran Charity Association CurrentSince Mar 1, 2020 Accepting new patients
Innovis Health, LLC Current Accepting new patients
Lutheran Charity Association Current Accepting new patients
Innovis Health, LLC. CurrentSince Oct 28, 2015 Accepting new patients
St Francis Medical Center Past Accepting new patients

Locations

3293 Solutions Ctr
Chicago, IL 60677

2400 St Francis Dr
Breckenridge, MN 56520
Phone (218) 643-0226

400 10th St E
Waconia, MN 55387

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000

2422 20th St SW
Jamestown, ND 58401
Phone (701) 252-1050

275 11th St S
Wahpeton, ND 58075
Phone (701) 642-2000

350 23rd Ave E
Ste 201
West Fargo, ND 58078
Phone (701) 356-4770

Organizations & group practices 11

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.

Hospital & facility affiliations 1

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": "1327536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348185600000",
    "number": "1407128135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581023641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 BROADWAY N",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581023641",
            "telephone_number": "701-234-5621",
            "fax_number": "701-234-7334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WENTZ",
        "first_name": "NINA",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-01-26",
        "last_updated": "2012-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ND",
            "license": "R31181",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "16728",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2012; 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.