Individual provider Active NPI

Josh T Wahl, CRNA

  • Certified Registered Nurse Anesthetist
  • Saint Paul, MN
National Provider Identifier
1649465394
Registry record updated Oct 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R158637-4 Issued in MN
Practice address
69 Exchange St W
Saint Paul, MN 55102-1004
Phone
(651) 735-0501
Fax
(651) 735-1870
NPI assigned
Sep 6, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2010

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 R158637-4 MN Primary

Addresses

Primary practice location

69 Exchange St W
Saint Paul, MN 55102-1004

Mailing address

8681 Eagle Point Blvd
Lake Elmo, MN 55042-8628
Phone (651) 251-8021

Other identifiers 1

IdentifierTypeStateIssuer
819402100MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20080121000043 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 7113008822 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southdale Anesthesiologists LLCGroup PAC ID 6709842461, 62 clinicians

Practice addresses (Care Compare)

6401 France Ave S
Edina, MN 55435-2104
Phone (952) 924-5000

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Southdale Anesthesiologists, LLC CurrentSince Nov 5, 2018 Accepting new patients

Locations

6401 France Ave S
Minneapolis, MN 55435
Phone (952) 920-8477

4010 W 65th St
Minneapolis, MN 55435
Phone (952) 456-7000

14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779

Organizations & group practices 1

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": "1189036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1286409600000",
    "number": "1649465394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8681 EAGLE POINT BLVD",
            "city": "LAKE ELMO",
            "state": "MN",
            "postal_code": "550428628",
            "telephone_number": "651-251-8021",
            "fax_number": "651-251-8050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "69 EXCHANGE ST W",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551021004",
            "telephone_number": "651-735-0501",
            "fax_number": "651-735-1870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAHL",
        "first_name": "JOSH",
        "middle_name": "T",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-06",
        "last_updated": "2010-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R158637-4",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "819402100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2010; 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.