Individual provider Active NPI

Randalyn Kaye Merriam, CRNA

  • Certified Registered Nurse Anesthetist
  • Minneapolis, MN
National Provider Identifier
1659370310
Registry record updated Jun 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R1542842 Issued in MN
Practice address
8100 Northland Dr
Minneapolis, MN 55431
Phone
(952) 831-8742
Fax
(952) 831-1626
NPI assigned
Jul 15, 2005
Last updated
Jun 13, 2018By the provider in NPPES
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 R1542842 MN Primary

Addresses

Primary practice location

8100 Northland Dr
Minneapolis, MN 55431

Mailing address

6465 Wayzata Blvd
Suite 315
St Louis Park, MN 55426-1728

Other practice location 1

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

Other identifiers 1

IdentifierTypeStateIssuer
814603900MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031201000121 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 4587569967 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

909 Fulton St SE
Minneapolis, MN 55455-4800
Phone (612) 672-7422

Merit-based Incentive Payment System (MIPS)

Final score
92.66 of 100Reported as group
Quality
79.17
Promoting interoperability
100
Improvement activities
40
Cost
73.43

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1219MNMDAthletic Trainer
R1542842MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
University of Minnesota Health Clinics and Surgery Center Inc Nurse Anesthetist, Certified Registered CurrentSince Apr 19, 2021 Accepting new patients
Tria Orthopaedic Center LLC Current Accepting new patients
Tria Orthopaedic Center LLC Nurse Anesthetist, Certified Registered CurrentSince Mar 15, 2005 Accepting new patients
University of Minnesota Health Clinics and Surgery Center, Inc. CurrentSince Apr 19, 2021 Accepting new patients
Tria Orthopaedic Center LLC CurrentSince Mar 15, 2005 Accepting new patients
University Anesthesia Providers, LLC Nurse Anesthetist, Certified Registered CurrentSince Apr 19, 2021 Accepting new patients
Twin Cities Anesthesia Associates PC Nurse Anesthetist, Certified Registered CurrentSince Sep 18, 2017 Accepting new patients
American Anesthesiology of Minnesota, P.a. Nurse Anesthetist, Certified Registered Past Accepting new patients

Locations

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

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

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

8100 Northland Dr
Minneapolis, MN 55431
Phone (952) 831-1626

909 Fulton St SE
Minneapolis, MN 55455
Phone (612) 273-8383

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

155 Radio Dr
Woodbury, MN 55125
Phone (952) 883-6212

Organizations & group practices 8

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1121385600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1528848000000",
    "number": "1659370310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6465 WAYZATA BLVD",
            "address_2": "SUITE 315",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554261728"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8100 NORTHLAND DR",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "55431",
            "telephone_number": "952-831-8742",
            "fax_number": "952-831-1626"
        }
    ],
    "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": "MERRIAM",
        "first_name": "RANDALYN",
        "middle_name": "KAYE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-15",
        "last_updated": "2018-06-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R1542842",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "814603900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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.