NPIMap

Organization Active NPI

Allina Health System

Doing business as Buffalo Hospital CRNA

  • Certified Registered Nurse Anesthetist
  • Buffalo, MN
National Provider Identifier
1649211756
Registry record updated Mar 22, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
ALLINA HEALTH SYSTEM
Doing business as
Buffalo Hospital CRNA
Practice address
303 Catlin St
Buffalo, MN 55313-1947
Phone
(763) 682-1212
NPI assigned
Jun 9, 2006
Last updated
Mar 22, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ALLINA HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2024

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

Authorized official

Name
Dominica Tallarico
Title
Coo
Phone
(612) 222-2222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse AnesthetistGroup: 193400000X SINGLE SPECIALTY GROUP 367500000X Primary

Addresses

Primary practice location

303 Catlin St
Buffalo, MN 55313-1947

Mailing address

14700 28TH Ave N
Suite 20
Plymouth, MN 55447-4835
Phone (763) 559-3779

Other names 1

  • Buffalo Hospital CRNA Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040319000460 MN Part B Supplier - Clinic/Group Practice 4587573613 Receives reassigned benefits from 4,246 practitioners
This NPI is an additional NPI on the enrollment

National Provider Directory

National Provider Directory
Tax ID family
Healthspan HLTH Sys CRP120 organizations share this tax ID, including this one
Part of
Healthspan HLTH Sys CRP

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Practitioners & affiliated clinicians

Practitioners 30

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

  • Scott Bertram, RN
    • Certified Registered Nurse Anesthetist
    • Saint Cloud, MN
    • NPI 1801226923

    Nurse Anesthetist, Certified Registered

    NPD
  • Amanda Lynn Braun
    • Certified Registered Nurse Anesthetist
    • St Louis Park, MN
    • NPI 1083256135

    Nurse Anesthetist, Certified Registered

    NPD
  • Erin Carlson, CRNA
    • Certified Registered Nurse Anesthetist
    • Minneapolis, MN
    • NPI 1225430614

    Nurse Anesthetist, Certified Registered

    NPD
  • Angela Deblieck
    • Certified Registered Nurse Anesthetist
    • Saint Cloud, MN
    • NPI 1598287641

    Nurse Anesthetist, Certified Registered

    NPD
  • Cameron Charles Hendrickson
    • Certified Registered Nurse Anesthetist
    • Saint Cloud, MN
    • NPI 1487264164

    Nurse Anesthetist, Certified Registered

    NPD
  • Bradley Hiivala, CRNA
    • Certified Registered Nurse Anesthetist
    • St Louis Park, MN
    • NPI 1477100543

    Nurse Anesthetist, Certified Registered

    NPD
  • Mark Janorschke, CRNA
    • Certified Registered Nurse Anesthetist
    • Avon, MN
    • NPI 1720055171

    Nurse Anesthetist, Certified Registered

    NPD
  • Sara Ketchum, CRNA
    • Certified Registered Nurse Anesthetist
    • Saint Cloud, MN
    • NPI 1720426802

    Nurse Anesthetist, Certified Registered

    NPD
  • Nicholas M Lejcher, CRNA
    • Certified Registered Nurse Anesthetist
    • Saint Cloud, MN
    • NPI 1033447172

    Nurse Anesthetist, Certified Registered

    NPD
  • Phoutphong Manivong, DNP, ARPN, CRNA
    • Certified Registered Nurse Anesthetist
    • Saint Cloud, MN
    • NPI 1447130620

    Nurse Anesthetist, Certified Registered

    NPD
  • Mark K Okeefe
    • Certified Registered Nurse Anesthetist
    • Plymouth, MN
    • NPI 1801465471

    Nurse Anesthetist, Certified Registered

    NPD
  • Samuel Patrick Faunillan Otis, CRNA
    • Certified Registered Nurse Anesthetist
    • St Louis Park, MN
    • NPI 1619452075

    Nurse Anesthetist, Certified Registered

    NPD
View all 30

NPI Registry JSON

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711065600000",
    "number": "1649211756",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14700 28TH AVE N",
            "address_2": "SUITE 20",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554474835",
            "telephone_number": "763-559-3779",
            "fax_number": "763-450-3986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 CATLIN ST",
            "city": "BUFFALO",
            "state": "MN",
            "postal_code": "553131947",
            "telephone_number": "763-682-1212"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALLINA HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ALLINA HEALTH SYSTEM",
        "enumeration_date": "2006-06-09",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A",
        "authorized_official_last_name": "TALLARICO",
        "authorized_official_first_name": "DOMINICA",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "612-222-2222"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Buffalo Hospital CRNA",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Buffalo Hospital CRNA",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Buffalo, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; 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.