NPIMap

Individual provider Active NPI

Mark Smeltzer

  • Anesthesiology Physician
  • Coon Rapids, MN
National Provider Identifier
1891085106
Registry record updated Jun 8, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
58853 Issued in MN
Practice address
4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522
Phone
(763) 559-3779
NPI assigned
Apr 8, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 8, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 58853 MN Primary

Addresses

Primary practice location

4050 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2522

Mailing address

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150917001020 MN Practitioner - Anesthesiology 7214244615 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Medical College of Wisconsin, 2011
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

Hospital & facility affiliations

  • Mercy Hospital Hospital, Coon Rapids, MN, CCN 240115
  • Cambridge Medical Center Hospital, Cambridge, MN, CCN 240020

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Metropolitan Anesthesia Network, LLP Anesthesiology CurrentSince Jul 1, 2015 Accepting new patients
Allina Health System Current Accepting new patients
Allina Health System CurrentSince Apr 7, 2020 Accepting new patients
Allina Health System CurrentSince Apr 7, 2020 Accepting new patients

Locations

11225 Ulysses St NE
Blaine, MN 55434
Phone (763) 302-2600

13601 80th Cir N
Ste 100
Maple Grove, MN 55369
Phone (612) 219-5355

2020 E 28th St
Ste 100
Minneapolis, MN 55407
Phone (612) 455-0612

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

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

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

550 Osborne Rd NE
Minneapolis, MN 55432
Phone (763) 236-3800

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

Organizations & group practices 4

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 12

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": "1302220800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1433721600000",
    "number": "1891085106",
    "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": "4050 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332522",
            "telephone_number": "763-559-3779"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SMELTZER",
        "first_name": "MARK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-08",
        "last_updated": "2015-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "MN",
            "license": "58853",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Coon Rapids, MN

Sources for this page

Verify at the official NPI Registry.