Individual provider Active NPI

Thomas Tate, APRN CRNA

  • Certified Registered Nurse Anesthetist
  • Saint Cloud, MN
National Provider Identifier
1740633106
Registry record updated Jan 26, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R 173900-8 Issued in MN
Practice address
3701 12TH St N
Suite 202
Saint Cloud, MN 56303-2255
Phone
(320) 258-3090
NPI assigned
Jul 20, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 26, 2017

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 R 173900-8 MN Primary

Addresses

Primary practice location

3701 12TH St N
Suite 202
Saint Cloud, MN 56303-2255

Mailing address

3701 12TH St N
Suite 202
Saint Cloud, MN 56303-2255
Phone (320) 258-3090

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170120000340 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 4688956022 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

3701 12TH St N
Suite 202
Saint Cloud, MN 56303-2253
Phone (320) 258-3090

Hospital & facility affiliations

  • Centracare - St. Cloud Hospital Hospital, Saint Cloud, MN, CCN 240036

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2033MNMDPulmonary Disease Physician
R 173900-8MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Centracare Clinic CurrentSince Oct 1, 2017 Accepting new patients
Centracare Clinic CurrentSince Oct 1, 2017 Accepting new patients
Centracare Clinic Current Accepting new patients

Locations

1200 6th Ave N
Saint Cloud, MN 56303
Phone (320) 252-3342

1900 Centracare Cir
Saint Cloud, MN 56303
Phone (320) 252-2422

1406 6th Ave N
Saint Cloud, MN 56303
Phone (320) 255-5657

3701 12th St N
Ste 202
Saint Cloud, MN 56303
Phone (320) 258-3090

Interoperability endpoints

  • Direct secure messaging: ttate334679@direct.centracare.com

Organizations & group practices 3

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.

Hospital & facility affiliations 6

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": "1468972800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1485388800000",
    "number": "1740633106",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3701 12TH ST N",
            "address_2": "SUITE 202",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032255",
            "telephone_number": "320-258-3090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3701 12TH ST N",
            "address_2": "SUITE 202",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032255",
            "telephone_number": "320-258-3090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATE",
        "first_name": "THOMAS",
        "credential": "APRN CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-07-20",
        "last_updated": "2017-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R 173900-8",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2017; 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.