Individual provider Active NPI

Jordan L Pickering

  • Certified Registered Nurse Anesthetist
  • Plymouth, MN
National Provider Identifier
1770152092
Registry record updated Dec 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
2618 Issued in MN
Practice address
14700 28TH Ave N Ste 20
Plymouth, MN 55447-4876
Phone
(763) 559-3779
Fax
(763) 450-3986
NPI assigned
Jun 21, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 2618 MN Primary
Student in an Organized Health Care Education/Training Program 390200000X R234444-7 MN

Addresses

Primary practice location

14700 28TH Ave N Ste 20
Plymouth, MN 55447-4876

Mailing address

PO Box 47159
Plymouth, MN 55447-0159
Phone (763) 559-3779

Other practice location 1

640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 254-6512

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211013002059 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 6406254945 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Allina Health SystemGroup PAC ID 4587573613, 3,844 clinicians
Metropolitan Anesthesia Network LLPGroup PAC ID 5698689123, 516 clinicians

Practice addresses (Care Compare)

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (651) 262-7633

800 E 28TH St
Minneapolis, MN 55407-3723
Phone (612) 863-5370

Hospital & facility affiliations

  • Abbott Northwestern Hospital Hospital, Minneapolis, MN, CCN 240057

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2618MNMDMarriage & Family Therapist
R234444-7MNMDStudent in an Organized Health Care Education/Training Program

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System CurrentSince Mar 11, 2025 Accepting new patients
Allina Health System CurrentSince Mar 11, 2025 Accepting new patients
Regions Hospital CurrentSince Nov 4, 2024 Accepting new patients
Allina Health System Current Accepting new patients
University Anesthesia Providers, LLC Nurse Anesthetist, Certified Registered CurrentSince Nov 1, 2024 Accepting new patients
Metropolitan Anesthesia Network, LLP Nurse Anesthetist, Certified Registered CurrentSince Oct 1, 2021 Accepting new patients
Regions Hospital CurrentSince Nov 4, 2024 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

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

800 E 28th St
Minneapolis, MN 55407
Phone (612) 863-3547

2925 Chicago Ave
Minneapolis, MN 55407
Phone (612) 262-4813

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

14700 28th Ave N
Ste 20
Plymouth, MN 55447
Phone (612) 559-3779

1575 Beam Ave
Saint Paul, MN 55109
Phone (651) 232-7000

640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164

Organizations & group practices 7

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 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1624233600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735603200000",
    "number": "1770152092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 47159",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554470159",
            "telephone_number": "763-559-3779",
            "fax_number": "763-450-3986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14700 28TH AVE N STE 20",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554474876",
            "telephone_number": "763-559-3779",
            "fax_number": "763-450-3986"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "640 Jackson St",
            "address_purpose": "LOCATION",
            "city": "Saint Paul",
            "state": "MN",
            "postal_code": "551012502",
            "country_code": "US",
            "telephone_number": "651-254-6512",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PICKERING",
        "first_name": "JORDAN",
        "middle_name": "L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-21",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "2618",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MN",
            "license": "R234444-7",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Plymouth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2024; 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.