NPIMap

Individual provider Active NPI

Bethany Marie Undis, CRNA

  • Certified Registered Nurse Anesthetist
  • Cambridge, MN
National Provider Identifier
1801974878
Registry record updated Mar 4, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R-111730-3 Issued in MN
Practice address
701 Dellwood St S
Cambridge, MN 55008-1920
Phone
(763) 689-7700
Fax
(763) 689-7941
NPI assigned
Nov 1, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2015

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-111730-3 MN Primary

Addresses

Primary practice location

701 Dellwood St S
Cambridge, MN 55008-1920

Mailing address

2925 Chicago Ave
Minneapolis, MN 55407-1321
Phone (612) 262-4813

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20051115000738 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 9830118249 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2005
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Josephs Medical CenterGroup PAC ID 8224948443, 238 clinicians

Practice addresses (Care Compare)

523 N 3Rd St
Brainerd, MN 56401-3054
Phone (218) 829-2861

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R-111730-3MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Allina Health System Current Accepting new patients
Brainerd Lakes Surgery Center L L C CurrentSince Aug 24, 2020 Accepting new patients
Allina Health System CurrentSince May 1, 2011 Accepting new patients
St. Joseph's Medical Center Current Accepting new patients
St Joseph's Medical Center CurrentSince Aug 24, 2020 Accepting new patients
Allina Health System CurrentSince May 1, 2011 Accepting new patients
St. Joseph's Medical Center CurrentSince Aug 24, 2020 Accepting new patients
Metropolitan Anesthesia Network, LLP Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2016 Accepting new patients
Mngi Digestive Health, P.a. CurrentSince Apr 2, 2018 Accepting new patients

Locations

13114 Isle Dr
Baxter, MN 56425
Phone (218) 822-2400

523 N 3rd St
Brainerd, MN 56401
Phone (218) 828-7394

701 Dellwood St S
Cambridge, MN 55008
Phone (763) 689-7700

9145 Springbrook Dr NW
Ste 200
Coon Rapids, MN 55433
Phone (612) 625-8999

3001 Broadway St NE
Ste 500
Minneapolis, MN 55413
Phone (612) 870-5557

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

8100 W 78th St
Ste 220
Minneapolis, MN 55439
Phone (952) 914-8400

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

2215 Park Ave
Minneapolis, MN 55404
Phone (612) 775-8800

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

9055 Springbrook Dr NW
Minneapolis, MN 55433
Phone (763) 780-9155

2925 Chicago Ave
#10957
Minneapolis, MN 55407
Phone (612) 262-8640

15700 37th Ave N
Plymouth, MN 55446
Phone (763) 577-0008

15700 37th Ave N
Ste 300
Plymouth, MN 55446
Phone (612) 870-5555

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

6500 Excelsior Blvd
St Louis Park, MN 55426
Phone (952) 993-3246

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 9

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 10

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": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425427200000",
    "number": "1801974878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2925 CHICAGO AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554071321",
            "telephone_number": "612-262-4813",
            "fax_number": "612-262-4194"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "701 DELLWOOD ST S",
            "city": "CAMBRIDGE",
            "state": "MN",
            "postal_code": "550081920",
            "telephone_number": "763-689-7700",
            "fax_number": "763-689-7941"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "UNDIS",
        "first_name": "BETHANY",
        "middle_name": "MARIE",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2015-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R-111730-3",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cambridge, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2015; 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.