Active NPI
Kendall Petty, CRNA
- Certified Registered Nurse Anesthetist
- Coon Rapids, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- R 135220-7
- Practice address
- 8990 Springbrook Dr NW
Suite 250
Coon Rapids, MN 55433-5850 - Phone
- (763) 398-0099
- Fax
- (763) 398-0124
- NPI assigned
- Jul 16, 2007
- 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 | R 135220-7 | MN | Primary |
Addresses
Primary practice location
8990 Springbrook Dr NW
Suite 250
Coon Rapids, MN 55433-5850
Mailing address
8990 Springbrook Dr NW
Suite 250
Coon Rapids, MN 55433-5850
Phone (763) 398-0099
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 430917000 | Medicaid | MN | |
| 53L81PE | Other | MN | BCBSMN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- University of Minnesota Medical School, 2007
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (651) 262-7633
Hospital & facility affiliations
- Abbott Northwestern Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R 135220-7 | MN | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Allina Health System | Current | Accepting new patients | |
| Metropolitan Anesthesia Network, LLP | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Allina Health System | Current | Accepting new patients | |
| Allina Health System | Current | Accepting new patients | |
| Certified Anesthesia Care, Co. | Nurse Anesthetist, Certified Registered | Past | Accepting new patients |
Locations
701 Dellwood St S
Cambridge, MN 55008
Phone (763) 689-7700
4050 Coon Rapids Blvd NW
Minneapolis, MN 55433
Phone (763) 236-6786
2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800
800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547
8100 W 78th St
Ste 220
Minneapolis, MN 55439
Phone (952) 914-8400
2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813
14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779
Organizations & group practices 5
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.
-
- Obstetrics & Gynecology Physician
- Buffalo, MN
- NPI 1295272342
-
- Anesthesiology Physician
- Plymouth, MN
- NPI 1558314427
Nurse Anesthetist, Certified Registered
-
- Oncology Clinic/Center
- Lakeville, MN
- NPI 1427884972
-
- Rheumatology Physician
- Coon Rapids, MN
- NPI 1952146516
-
- Certified Registered Nurse Anesthetist
- Stillwater, MN
- NPI 1699736348
Nurse Anesthetist, Certified Registered
Hospital & facility affiliations 23
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Obesity Medicine (Family Medicine) Physician
- Minneapolis, MN
- NPI 1154684835
Hospital
-
- Physical Medicine & Rehabilitation Physician
- Minneapolis, MN
- NPI 1275577215
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1184544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1211155200000",
"number": "1720287154",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8990 SPRINGBROOK DR NW",
"address_2": "SUITE 250",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554335850",
"telephone_number": "763-398-0099",
"fax_number": "763-398-0124"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8990 SPRINGBROOK DR NW",
"address_2": "SUITE 250",
"city": "COON RAPIDS",
"state": "MN",
"postal_code": "554335850",
"telephone_number": "763-398-0099",
"fax_number": "763-398-0124"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTY",
"first_name": "KENDALL",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-16",
"last_updated": "2008-05-19",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MN",
"license": "R 135220-7",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "430917000",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBSMN",
"identifier": "53L81PE",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coon Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2008; 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.