Individual provider Active NPI

Dexter Peries, CRNA

  • Certified Registered Nurse Anesthetist
  • Grand Forks, ND
National Provider Identifier
1760105878
Registry record updated Sep 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R42119 Issued in ND
Practice address
1200 S Columbia Rd
Grand Forks, ND 58201-4044
Phone
(701) 780-5270
NPI assigned
Sep 22, 2022
Last updated
Sep 22, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2022

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 R42119 ND Primary

Addresses

Primary practice location

1200 S Columbia Rd
Grand Forks, ND 58201-4044

Mailing address

526 Washington Ave
Crookston, MN 56716-2060
Phone (701) 306-1566

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20221114002139 ND Practitioner - Certified Registered Nurse Anesthetist (Crna) 7719354208 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Altru Health SystemGroup PAC ID 1355251604, 675 clinicians

Practice addresses (Care Compare)

1200 S Columbia Rd
Grand Forks, ND 58201-4036
Phone (701) 780-5000

1380 S Columbia Rd
Grand Forks, ND 58201-4059
Phone (701) 795-2000

4500 S Washington St
Suite B
Grand Forks, ND 58201-7217
Phone (701) 732-7400

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
R42119NDMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Altru Health System Current Accepting new patients
Altru Health System CurrentSince Oct 10, 2022 Accepting new patients
Altru Health System CurrentSince Oct 10, 2022 Accepting new patients

Locations

1200 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 780-5243

1380 S Columbia Rd
Grand Forks, ND 58201
Phone (701) 795-2000

2401 Demers Ave
Grand Forks, ND 58201
Phone (701) 780-1891

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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": "1663804800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663804800000",
    "number": "1760105878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "526 WASHINGTON AVE",
            "city": "CROOKSTON",
            "state": "MN",
            "postal_code": "567162060",
            "telephone_number": "701-306-1566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 S COLUMBIA RD",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582014044",
            "telephone_number": "701-780-5270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERIES",
        "first_name": "DEXTER",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-09-22",
        "last_updated": "2022-09-22",
        "certification_date": "2022-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ND",
            "license": "R42119",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Forks, ND

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2022; 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.