Individual provider Active NPI

Shanon L Kjelstad, CRNA

  • Certified Registered Nurse Anesthetist
  • Coon Rapids, MN
National Provider Identifier
1851393649
Registry record updated May 15, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R 125106-5 Issued in MN
Practice address
8990 Springbrook Dr NW
Coon Rapids, MN 55433-5884
Phone
(763) 398-0099
Fax
(763) 398-0124
NPI assigned
Aug 11, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 15, 2008

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 125106-5 MN Primary

Addresses

Primary practice location

8990 Springbrook Dr NW
Coon Rapids, MN 55433-5884

Mailing address

17241 Partridge St NW
Andover, MN 55304-1453

Other identifiers 2

IdentifierTypeStateIssuer
817918200MedicaidMN
210G5KJOtherMNBCBSMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050112000404 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 1254389612 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Metropolitan Anesthesia Network LLPGroup PAC ID 5698689123, 516 clinicians

Practice addresses (Care Compare)

4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522
Phone (763) 236-6786

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R 125106-5MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Certified Anesthesia Care, Co. Nurse Anesthetist, Certified Registered CurrentSince Aug 1, 2017 Accepting new patients
Allina Health System Nurse Anesthetist, Certified Registered CurrentSince Mar 3, 2023 Accepting new patients
Central Minnesota Anesthesia Providers, PA Nurse Anesthetist, Certified Registered CurrentSince Jul 1, 2018 Accepting new patients
Allina Health System Current Accepting new patients
Metropolitan Anesthesia Network, LLP Nurse Anesthetist, Certified Registered CurrentSince Jun 1, 2016 Accepting new patients
Allina Health System CurrentSince Mar 3, 2023 Accepting new patients
Cogent Healthcare of Washington, PC Past Accepting new patients
Suburban Radiologic Consultants, LTD. Past Accepting new patients

Locations

14054 Bank St
Becker, MN 55308
Phone (763) 260-8808

9801 DuPont Ave S
Ste 100
Bloomington, MN 55431

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

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

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

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

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

400 10th St E
Waconia, MN 55387

Organizations & group practices 8

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.

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1210809600000",
    "number": "1851393649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17241 PARTRIDGE ST NW",
            "city": "ANDOVER",
            "state": "MN",
            "postal_code": "553041453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8990 SPRINGBROOK DR NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335884",
            "telephone_number": "763-398-0099",
            "fax_number": "763-398-0124"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KJELSTAD",
        "first_name": "SHANON",
        "middle_name": "L",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-11",
        "last_updated": "2008-05-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R 125106-5",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "817918200",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSMN",
            "identifier": "210G5KJ",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coon Rapids, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2008; 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.