NPIMap

Individual provider Active NPI

Mara Patricia Prusak, RN, CRNA

  • Certified Registered Nurse Anesthetist
  • Duluth, MN
National Provider Identifier
1669604880
Registry record updated Mar 11, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R1652813 Issued in MN
Practice address
400 E 3Rd St
Duluth Clinic
Duluth, MN 55805-1951
Phone
(218) 786-4150
NPI assigned
Aug 21, 2009
Last updated
Mar 11, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2021

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 R1652813 MN Primary

Addresses

Primary practice location

400 E 3Rd St
Duluth Clinic
Duluth, MN 55805-1951

Mailing address

8170 33Rd Ave S # Ms 21110Q
Bloomington, MN 55425-4516

Other practice location 1

8100 Northland Dr
Bloomington, MN 55431-4800
Phone (952) 831-8742

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100208000759 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 1254479926 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians
Mngi Digestive Health PAGroup PAC ID 8123016557, 276 clinicians

Practice addresses (Care Compare)

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (651) 262-7633

3001 Broadway St NE
Suite 500
Minneapolis, MN 55413-2197
Phone (612) 871-1145

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R1652813MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Tria Orthopaedic Center LLC Nurse Anesthetist, Certified Registered CurrentSince Jul 17, 2017 Accepting new patients
Allina Health System Current Accepting new patients
Tria Orthopaedic Center LLC CurrentSince Jul 17, 2017 Accepting new patients
Metropolitan Anesthesia Network, LLP Nurse Anesthetist, Certified Registered CurrentSince Feb 8, 2020 Accepting new patients
Mngi Digestive Health, P.a. CurrentSince Apr 2, 2018 Accepting new patients
Allina Health System CurrentSince Apr 17, 2025 Accepting new patients
Twin Cities Anesthesia Associates PC Nurse Anesthetist, Certified Registered CurrentSince Sep 18, 2017 Accepting new patients
Allina Health System CurrentSince Apr 17, 2025 Accepting new patients

Locations

5705 W Old Shakopee Rd
Ste 150
Bloomington, MN 55437
Phone (612) 870-5530

701 Dellwood St S
Cambridge, MN 55008
Phone (763) 689-7700

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

1185 Town Centre Dr
Ste 205
Eagan, MN 55123

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

3001 Broadway St NE
Ste 500
Minneapolis, MN 55413
Phone (612) 870-5557

4050 Coon Rapids Blvd NW
Minneapolis, MN 55433
Phone (763) 236-6786

800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547

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

8100 W 78th St
Ste 220
Minneapolis, MN 55439
Phone (952) 914-8400

8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375

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

15700 37th Ave N
Plymouth, MN 55446
Phone (763) 577-0008

15700 37th Ave N
Ste 300
Plymouth, MN 55446
Phone (612) 870-5555

2635 University Ave W
Ste 100
Saint Paul, MN 55114
Phone (612) 435-8700

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

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

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

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

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.

Hospital & facility affiliations 23

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1250812800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1615420800000",
    "number": "1669604880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 33RD AVE S # MS 21110Q",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554254516"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "address_2": "DULUTH CLINIC",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-4150"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8100 Northland Dr",
            "address_purpose": "LOCATION",
            "city": "Bloomington",
            "state": "MN",
            "postal_code": "554314800",
            "country_code": "US",
            "telephone_number": "952-831-8742",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PRUSAK",
        "first_name": "MARA",
        "middle_name": "PATRICIA",
        "credential": "RN, CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-21",
        "last_updated": "2021-03-11",
        "certification_date": "2021-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R1652813",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2021; 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.