Individual provider Active NPI

Amanda Jean Gross, CRNA

  • Certified Registered Nurse Anesthetist
  • Fargo, ND
National Provider Identifier
1609184043
Registry record updated Apr 20, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R30715 Issued in ND
Practice address
3000 32ND Ave S
Fargo, ND 58103-6132
Phone
(701) 364-8000
NPI assigned
Sep 20, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 20, 2012

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X R30715 ND Primary
Certified Registered Nurse Anesthetist 367500000X R176928-5 MN

Addresses

Primary practice location

3000 32ND Ave S
Fargo, ND 58103-6132

Mailing address

PO Box 6001
Fargo, ND 58108-6001
Phone (701) 364-8000

Other identifiers 1

IdentifierTypeStateIssuer
15472MedicaidND

Other names 1

  • Amanda Jean Hornung Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101220000457 ND Practitioner - Certified Registered Nurse Anesthetist (Crna) 0143418053 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Innovis Health LLCGroup PAC ID 9931298155, 561 clinicians

Practice addresses (Care Compare)

3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R176928-5MNMDCertified Registered Nurse Anesthetist
R30715NDMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo CurrentSince May 18, 2022 Accepting new patients
Innovis Health, LLC Current Accepting new patients
Innovis Health, LLC. CurrentSince Nov 15, 2010 Accepting new patients
Innovis Health LLC CurrentSince Nov 15, 2010 Accepting new patients
Sanford Medical Center Fargo CurrentSince May 18, 2022 Accepting new patients

Locations

3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Organizations & group practices 5

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": "1284940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334880000000",
    "number": "1609184043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6001",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581086001",
            "telephone_number": "701-364-8000",
            "fax_number": "701-364-8078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 32ND AVE S",
            "city": "FARGO",
            "state": "ND",
            "postal_code": "581036132",
            "telephone_number": "701-364-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GROSS",
        "first_name": "AMANDA",
        "middle_name": "JEAN",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-20",
        "last_updated": "2012-04-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ND",
            "license": "R30715",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R176928-5",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "15472",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "HORNUNG",
            "middle_name": "JEAN",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fargo, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2012; 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.