Kelly Ray Shantz, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

868 Issued in MN

Practice address

800 Medical Center Dr
Fairmont, MN 56031-4575

Phone

(507) 238-8555

NPI assigned

Sep 29, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mayo Clinic Health System-Southeast Minnesota RegionGroup PAC ID 4385556703, 550 clinicians

Mayo Clinic Health System-Southwest Minnesota RegionGroup PAC ID 4688585771, shared by 6 NPIs, 658 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mayo Clinic Health System - Mankato Hospital, Mankato, MN, CCN 240093
• Mayo Clinic Health System - Albert Lea and Austin Hospital, Albert Lea, MN, CCN 240043

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kshantz87838@ehrdirect.mayoclinicmsg.org

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.

• Mayo Clinic Health System-Southeast Minnesota Region

  • Multi-Specialty Clinic/Center
  • Albert Lea, MN
  • NPI 1891701637
  Medicare reassignment Care Compare group NPD
• Mayo Clinic Health System-Fairmont

  • Multi-Specialty Clinic/Center
  • Fairmont, MN
  • NPI 1366410862
  Medicare reassignment NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Multi-Specialty Clinic/Center
  • Mankato, MN
  • NPI 1578545422
  Medicare reassignment NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Critical Access Hospital
  • Waseca, MN
  • NPI 1740256668
  Medicare reassignment NPD
• Mayo Clinic Health System-St James

  • Multi-Specialty Clinic/Center
  • Saint James, MN
  • NPI 1023177730
  Medicare reassignment NPD
• Mayo Clinic Health System-Southeast Minnesota Region

  • Multi-Specialty Clinic/Center
  • Red Wing, MN
  • NPI 1114453883
  NPD
• Mayo Clinic Health System-Southeast Minnesota Region

  • Clinic Pharmacy
  • Cannon Falls, MN
  • NPI 1699597468
  NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Multi-Specialty Clinic/Center
  • New Prague, MN
  • NPI 1477089407
  NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Multi-Specialty Clinic/Center
  • Waseca, MN
  • NPI 1518494251
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mayo Clinic Health System-Southeast Minnesota Region

  • General Acute Care Hospital
  • Albert Lea, MN
  • NPI 1346258100
  Care Compare affiliation
• Mayo Clinic Health System-Southwest Minnesota Region

  • General Acute Care Hospital
  • Mankato, MN
  • NPI 1154302487
  Care Compare affiliation

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600300800000",
    "number": "1477540995",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 MEDICAL CENTER DR",
            "city": "FAIRMONT",
            "state": "MN",
            "postal_code": "560314575",
            "telephone_number": "507-238-8555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 MEDICAL CENTER DR",
            "city": "FAIRMONT",
            "state": "MN",
            "postal_code": "560314575",
            "telephone_number": "507-238-8555"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "805 Johnson St",
            "address_purpose": "LOCATION",
            "city": "Fairmont",
            "state": "MN",
            "postal_code": "560314523",
            "country_code": "US",
            "telephone_number": "507-238-8100 x8166",
            "fax_number": "507-238-8642",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SHANTZ",
        "first_name": "KELLY",
        "middle_name": "RAY",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-29",
        "last_updated": "2020-09-17",
        "certification_date": "2020-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R 162289-8",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "868",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kshantz87838@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "800 Medical Center Dr",
            "city": "Fairmont",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560314575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Mary Beth Sebas, FNP
• Amanda Seibert, PHARM. D.
• Paul Alan Seibert, O.D
• Spencer Seibert, OD
• Ryan Selbrade
• Timothy Sheneman, D.O.
• Anne Sheppard, RD
• Kristine Marie Shoen, LICSW
• Maurice Lee Shoen
• Rhonda Lee Shoen, RN

• Certified Registered Nurse Anesthetist in Fairmont, MN
• Providers in Fairmont, MN by specialty
• Certified Registered Nurse Anesthetist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2020; 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.