Glacial Lakes Anesthesia, PLLC

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

Legal business name

GLACIAL LAKES ANESTHESIA, PLLC

Practice address

1512 4TH St NE
Watertown, SD 57201-6824

Phone

(605) 884-0100

Fax

(952) 442-3620

NPI assigned

Dec 8, 2022

Organization subpart

No

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

Authorized official

Name

Michael J Bevers, CRNANPI 1962727339

Title

Owner

Phone

(507) 272-1629

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael J Bevers

  • Certified Registered Nurse Anesthetist
  • Shawnee Mission, KS
  • NPI 1962727339

  Nurse Anesthetist, Certified Registered, SD

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1670457600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670457600000",
    "number": "1841901923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 10TH ST E",
            "city": "WACONIA",
            "state": "MN",
            "postal_code": "553874552",
            "telephone_number": "952-442-9770",
            "fax_number": "952-442-3620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1512 4TH ST NE",
            "city": "WATERTOWN",
            "state": "SD",
            "postal_code": "572016824",
            "telephone_number": "605-884-0100",
            "fax_number": "952-442-3620"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIAL LAKES ANESTHESIA, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-08",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A",
        "authorized_official_last_name": "BEVERS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "507-272-1629",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Connie Gertsen
• Gregory Alan Gertsen, DDS
• Robert W Giebink, MD
• Emily Givens
• Lindsey Givens, RN
• Kristie L Goens, CNP
• Good Samaritan - Sioux Valley Community Health Services
• Matthew Bryan Gottesman, AUD
• Brody Grantham, DDS
• Amber Grengs, BCBA

• Certified Registered Nurse Anesthetist in Watertown, SD
• Providers in Watertown, SD by specialty
• Certified Registered Nurse Anesthetist in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.