Individual provider Active NPI

Jerin C Coppenger, CRNA

  • Certified Registered Nurse Anesthetist
  • Minneapolis, MN
National Provider Identifier
1578537387
Registry record updated Jun 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R 122892-0 Issued in MN
Practice address
2450 Riverside Ave
Minneapolis, MN 55454
Phone
(612) 672-6000
NPI assigned
Feb 16, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2018

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 R 122892-0 MN Primary

Addresses

Primary practice location

2450 Riverside Ave
Minneapolis, MN 55454

Mailing address

2450 Riverside Ave
Minneapolis, MN 55454-1450

Other practice location 1

9645 Grove Cir N Ste 250
Maple Grove, MN 55369-4466
Phone (763) 201-8191

Other identifiers 1

IdentifierTypeStateIssuer
556518900MedicaidMN

Other names 1

  • Jerin C McRath Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060314000111 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 0345257556 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1992
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Metropolitan Anesthesia PAGroup PAC ID 1153370911, 25 clinicians

Practice addresses (Care Compare)

201 E Nicollet Blvd
Burnsville, MN 55337-5714
Phone (952) 892-2000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R 122892-0MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
University Anesthesia Providers, LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2016 Accepting new patients
South Metropolitan Anesthesia, PA Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2020 Accepting new patients

Locations

201 E Nicollet Blvd
Burnsville, MN 55337
Phone (952) 892-2000

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

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

400 10th St E
Waconia, MN 55387

Organizations & group practices 2

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 2

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": "1140048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528848000000",
    "number": "1578537387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55454",
            "telephone_number": "612-672-6000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9645 Grove Cir N Ste 250",
            "address_purpose": "LOCATION",
            "city": "Maple Grove",
            "state": "MN",
            "postal_code": "553694466",
            "country_code": "US",
            "telephone_number": "763-201-8191",
            "fax_number": "763-201-8192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COPPENGER",
        "first_name": "JERIN",
        "middle_name": "C",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-16",
        "last_updated": "2018-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R 122892-0",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "556518900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JERIN",
            "last_name": "MCRATH",
            "middle_name": "C",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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 Jun 13, 2018; 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.