Individual provider Active NPI

Celesta Cartrite Myland, M.S.,CCC/A

  • Audiologist
  • Excelsior, MN
National Provider Identifier
1578649042
Registry record updated Nov 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
8430 Issued in MN
Practice address
675 Water St
Excelsior, MN 55331-3072
Phone
(952) 925-5626
Fax
(952) 925-0223
NPI assigned
Oct 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 25, 2008

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 8430 MN Primary
Assistive Technology Supplier Audiologist 231HA2500X 8430 MN

Addresses

Primary practice location

675 Water St
Excelsior, MN 55331-3072

Mailing address

675 Water St
Excelsior, MN 55331-3072
Phone (952) 925-5626

Other identifiers 1

IdentifierTypeStateIssuer
1578649042MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090305000721 MN Practitioner - Qualified Audiologist 0547154924 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
50797TXMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Ridgeview Medical Center Current Accepting new patients
Carlson Chiropractic Health and Healing Inc. PastSince Jun 7, 2018 Accepting new patients
US Health Dept of Health & Human Services Past Accepting new patients
Ridgeview Clinics Past Accepting new patients
Wind River Hearing Services Past Accepting new patients
US Health Dept of Health & Human Services Past Accepting new patients

Locations

500 S Maple St
Waconia, MN 55387
Phone (612) 442-2191

Interoperability endpoints

  • Direct secure messaging: cmyland733991@excellian.direct.allina.com

Organizations & group practices 6

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": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1227571200000",
    "number": "1578649042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 WATER ST",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553313072",
            "telephone_number": "952-925-5626",
            "fax_number": "952-925-0223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 WATER ST",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553313072",
            "telephone_number": "952-925-5626",
            "fax_number": "952-925-0223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MYLAND",
        "first_name": "CELESTA",
        "middle_name": "CARTRITE",
        "credential": "M.S.,CCC/A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-27",
        "last_updated": "2008-11-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "MN",
            "license": "8430",
            "primary": true
        },
        {
            "code": "231HA2500X",
            "taxonomy_group": "",
            "desc": "Audiologist, Assistive Technology Supplier",
            "state": "MN",
            "license": "8430",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1578649042",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Excelsior, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.