NPIMap

Individual provider Active NPI

Shannon L Roe, CRNA

  • Certified Registered Nurse Anesthetist
  • Minneapolis, MN
National Provider Identifier
1528124468
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R1320572 Issued in MN
Practice address
2525 Chicago Avenue S
Childrens Hospital and Clinics of Minnesota
Minneapolis, MN 55404
Phone
(612) 813-6273
Fax
(615) 813-7380
NPI assigned
Dec 28, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 R1320572 MN Primary

Addresses

Primary practice location

2525 Chicago Avenue S
Childrens Hospital and Clinics of Minnesota
Minneapolis, MN 55404

Mailing address

2910 Centre Pointe Drive
35 121A
Roseville, MN 55113
Phone (651) 855-2109

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160210002808 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 5890099816 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Metropolitan Anesthesia Network LLPGroup PAC ID 5698689123, 516 clinicians

Practice addresses (Care Compare)

6099 Wayzata Blvd
Suite 300
St Louis Park, MN 55416-5538
Phone (612) 832-9360

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
955MNMDPediatric Nurse Practitioner
R1320572MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Metropolitan Anesthesia Network, LLP Nurse Anesthetist, Certified Registered CurrentSince Apr 1, 2022 Accepting new patients
University Anesthesia Providers, LLC Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2021 Accepting new patients

Locations

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

2525 Chicago Ave
Minneapolis, MN 55404
Phone (612) 813-6000

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

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

6099 Wayzata Blvd
Ste 300
St Louis Park, MN 55416
Phone (612) 832-9360

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528124468",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2910 CENTRE POINTE DRIVE",
            "address_2": "35 121A",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "55113",
            "telephone_number": "651-855-2109",
            "fax_number": "651-855-2310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2525 CHICAGO AVENUE S",
            "address_2": "CHILDRENS HOSPITAL AND CLINICS OF MINNESOTA",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55404",
            "telephone_number": "612-813-6273",
            "fax_number": "615-813-7380"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROE",
        "first_name": "SHANNON",
        "middle_name": "L",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-12-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R1320572",
            "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 Jul 8, 2007; 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.