Active NPI
Leo J Lantz, CRNA
- Certified Registered Nurse Anesthetist
- Fargo, ND
National Provider Identifier
1720022296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- R24550
- Practice address
- 3000 32ND Ave S
Fargo, ND 58103-6132 - Phone
- (701) 364-8000
- Fax
- (701) 364-8078
- NPI assigned
- Jun 15, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | R24550 | ND | Primary |
Addresses
Primary practice location
3000 32ND Ave S
Fargo, ND 58103-6132
Mailing address
PO Box 6001
Fargo, ND 58108-6001
Phone (701) 364-3300
Other identifiers 9
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 142339 | Other | ND | UCARE # |
| DA9011015555 | Other | ND | PREF 1 |
| HP38625 | Other | ND | HEALTHPARTNERS # |
| 2000789 | Other | ND | MEDICA INNOVIS # |
| 38T21LA | Other | ND | MNBS # |
| 2000790 | Other | ND | MEDICA FARGO # |
| 3881 | Other | ND | NDBS # |
| 029018100 | Medicaid | ND | |
| 12655 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
3000 32ND Ave S
Fargo, ND 58103-6132
Phone (701) 364-8000
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 48051 | ND | MD | Community Health Worker |
| R24550 | ND | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Innovis Health LLC | Current | Accepting new patients | |
| Innovis Health LLC | Current | Accepting new patients | |
| Innovis Health, LLC | Current | Accepting new patients | |
| Dakota Specialty Institute | Past | Accepting new patients |
Locations
3000 32nd Ave S
Fargo, ND 58103
Phone (701) 364-3000
1702 University Dr S
Fargo, ND 58103
Phone (701) 364-4222
Organizations & group practices 4
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.
-
dba Essentia Health-Osgood Clinic
- Multi-Specialty Clinic/Center
- Fargo, ND
- NPI 1144776576
-
dba Essentia Health Moorhead Clinic
- Family Medicine Physician
- Moorhead, MN
- NPI 1659617504
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1150329600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1339545600000",
"number": "1720022296",
"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": "701-364-3300",
"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",
"fax_number": "701-364-8078"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LANTZ",
"first_name": "LEO",
"middle_name": "J",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-15",
"last_updated": "2012-06-13",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "ND",
"license": "R24550",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE #",
"identifier": "142339",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREF 1",
"identifier": "DA9011015555",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS #",
"identifier": "HP38625",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA INNOVIS #",
"identifier": "2000789",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MNBS #",
"identifier": "38T21LA",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA FARGO #",
"identifier": "2000790",
"state": "ND"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NDBS #",
"identifier": "3881",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "029018100",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "12655",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}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 Jun 13, 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.