Individual provider Active NPI

Betsy S Ellingson, CRNA

  • Certified Registered Nurse Anesthetist
  • Minneapolis, MN
National Provider Identifier
1457479495
Registry record updated Mar 10, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
040060 Issued in MN
Practice address
3001 Broadway St NE Ste 500
Minneapolis, MN 55413-2197
Phone
(128) 711-1456
Fax
(612) 870-5491
NPI assigned
Mar 27, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2021

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 040060 MN Primary

Addresses

Primary practice location

3001 Broadway St NE Ste 500
Minneapolis, MN 55413-2197

Mailing address

PO Box 14909
Minneapolis, MN 55414-0909
Phone (612) 871-1145

Other identifiers 1

IdentifierTypeStateIssuer
357842900MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080929000415 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 6901973270 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mngi Digestive Health PAGroup PAC ID 8123016557, 276 clinicians

Practice addresses (Care Compare)

3001 Broadway St NE
Suite 500
Minneapolis, MN 55413-2197
Phone (612) 871-1145

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
040060MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Mngi Digestive Health, P.a. CurrentSince Mar 17, 2021 Accepting new patients
Affiliated Endoscopy Centers, LLC Past Accepting new patients
Mngi Endoscopy ASC Inc PastSince Mar 16, 2021 Accepting new patients

Locations

5705 W Old Shakopee Rd
Ste 150
Bloomington, MN 55437
Phone (612) 870-5530

9145 Springbrook Dr NW
Ste 200
Coon Rapids, MN 55433
Phone (612) 625-8999

3001 Broadway St NE
Ste 500
Minneapolis, MN 55413
Phone (612) 870-5557

15700 37th Ave N
Plymouth, MN 55446
Phone (763) 577-0008

15700 37th Ave N
Ste 300
Plymouth, MN 55446
Phone (612) 870-5555

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615334400000",
    "number": "1457479495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 14909",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554140909",
            "telephone_number": "612-871-1145",
            "fax_number": "612-870-5491"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 BROADWAY ST NE STE 500",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554132197",
            "telephone_number": "128-711-1456",
            "fax_number": "612-870-5491"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLINGSON",
        "first_name": "BETSY",
        "middle_name": "S",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-27",
        "last_updated": "2021-03-10",
        "certification_date": "2021-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "040060",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "357842900",
            "state": "MN"
        }
    ],
    "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 10, 2021; 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.