NPIMap

Individual provider Active NPI

Jacqueline Kay Ford Dufour, CRNA

  • Certified Registered Nurse Anesthetist
  • Roseville, MN
National Provider Identifier
1720414832
Registry record updated Sep 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R180766-8 Issued in MN
Practice address
2700 Snelling Ave N
Suite 400
Roseville, MN 55113-1719
Phone
(651) 697-5863
NPI assigned
Sep 20, 2013
Last updated
Sep 20, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 20, 2013

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 R180766-8 MN Primary

Addresses

Primary practice location

2700 Snelling Ave N
Suite 400
Roseville, MN 55113-1719

Mailing address

2700 Snelling Ave N
Suite 400
Roseville, MN 55113-1719
Phone (651) 697-5863

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140108000424 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 9931337433 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Certified Anesthesia Care CoGroup PAC ID 9436439114, 26 clinicians
Metropolitan Anesthesia Network LLPGroup PAC ID 5698689123, 516 clinicians

Practice addresses (Care Compare)

1687 Woodlane Dr
Woodbury, MN 55125-3045
Phone (651) 600-3035

333 Smith Ave N
Saint Paul, MN 55102-2344
Phone (651) 241-8000

9801 Dupont Ave S
Suite 100
Bloomington, MN 55431-3100
Phone (952) 888-5800

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1395MNMDAcupuncturist
R180766-8MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Metropolitan Anesthesia Network, LLP Nurse Anesthetist, Certified Registered CurrentSince Sep 1, 2019 Accepting new patients
Certified Anesthesia Care, Co. Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2025 Accepting new patients

Locations

9801 DuPont Ave S
Ste 100
Bloomington, MN 55431

2020 E 28th St
Ste 100
Minneapolis, MN 55407
Phone (612) 455-0612

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

333 Smith Ave N
Saint Paul, MN 55102
Phone (651) 220-8256

400 10th St E
Waconia, MN 55387

1687 Woodlane Dr
Woodbury, MN 55125
Phone (651) 209-6685

2080 Woodwinds Dr
Ste 200
Woodbury, MN 55125
Phone (651) 642-1106

Organizations & group practices 2

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 16

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

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1379635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379635200000",
    "number": "1720414832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2700 SNELLING AVE N",
            "address_2": "SUITE 400",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131719",
            "telephone_number": "651-697-5863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2700 SNELLING AVE N",
            "address_2": "SUITE 400",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551131719",
            "telephone_number": "651-697-5863"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUFOUR",
        "first_name": "JACQUELINE",
        "middle_name": "KAY FORD",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-20",
        "last_updated": "2013-09-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R180766-8",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roseville, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2013; 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.