NPIMap

Organization Active NPI

Central Minnesota Anesthesia Providers, PA

  • Certified Registered Nurse Anesthetist
  • Becker, MN
National Provider Identifier
1881689974
Registry record updated Nov 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
Legal business name
CENTRAL MINNESOTA ANESTHESIA PROVIDERS, PA
Practice address
14054 Bank St
Box 100
Becker, MN 55308-0100
Phone
(763) 260-8808
Fax
(763) 645-5579
NPI assigned
Sep 14, 2005
Last updated
Nov 2, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2015

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

Authorized official

Name
Dave Schultz, CRNA
Title
President
Phone
(763) 218-4125

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X NU Primary

Addresses

Primary practice location

14054 Bank St
Box 100
Becker, MN 55308-0100

Mailing address

911 Northland Dr
Princeton, MN 55371-2172
Phone (763) 389-6384

Other identifiers 1

IdentifierTypeStateIssuer
003496700MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040116000877 MN Part B Supplier - Clinic/Group Practice 7315848876 Receives reassigned benefits from 52 practitioners
Practice locations: Princeton, MN

National Provider Directory

National Provider Directory

Locations

14054 Bank St
#100
Becker, MN 55308
Phone (763) 260-8808

14500 99th Ave N
Ste 500
Maple Grove, MN 55369
Phone (763) 898-1400

Practitioners & affiliated clinicians

Practitioners 54

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 54

NPI Registry JSON

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

{
    "created_epoch": "1126656000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1446422400000",
    "number": "1881689974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 NORTHLAND DR",
            "city": "PRINCETON",
            "state": "MN",
            "postal_code": "553712172",
            "telephone_number": "763-389-6384",
            "fax_number": "763-389-6389"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14054 BANK ST",
            "address_2": "BOX 100",
            "city": "BECKER",
            "state": "MN",
            "postal_code": "553080100",
            "telephone_number": "763-260-8808",
            "fax_number": "763-645-5579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL MINNESOTA ANESTHESIA PROVIDERS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-14",
        "last_updated": "2015-11-02",
        "status": "A",
        "authorized_official_last_name": "SCHULTZ",
        "authorized_official_first_name": "DAVE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "763-218-4125",
        "authorized_official_credential": "CRNA"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003496700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Becker, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2015; 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.