Individual provider Active NPI

Glen David Palokangas, APRN, CRNA

  • Certified Registered Nurse Anesthetist
  • Cloquet, MN
National Provider Identifier
1932416435
Registry record updated Dec 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
R155380-2 Issued in MN
Practice address
512 Skyline Blvd Ste 1
Cloquet, MN 55720-1199
Phone
(218) 879-4641
NPI assigned
Sep 3, 2010
Last updated
Dec 11, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2024

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 R155380-2 MN Primary

Addresses

Primary practice location

512 Skyline Blvd Ste 1
Cloquet, MN 55720-1199

Mailing address

512 Skyline Blvd Ste 1
Cloquet, MN 55720-1199
Phone (218) 879-4641

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hisdept@direct.cloquethospital.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110318000647 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 5799967394 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

512 Skyline Blvd
Cloquet, MN 55720-3787
Phone (218) 879-4641

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
1078MNMDAcupuncturist
R155380-2MNMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Northland Anesthesia Associates Nurse Anesthetist, Certified Registered CurrentSince Apr 15, 2017 Accepting new patients
Range Regional Health Services CurrentSince Sep 24, 2018 Accepting new patients
Range Regional Health Services CurrentSince Sep 24, 2018 Accepting new patients
North Shore Anesthesia P.a Nurse Anesthetist, Certified Registered CurrentSince Dec 26, 2014 Accepting new patients
Community Memorial Hospital Association PastSince Dec 15, 2024 Accepting new patients

Locations

10 5th St SE
Cook, MN 55723
Phone (218) 626-3441

1420 London Rd
Ste 100
Duluth, MN 55805
Phone (218) 728-0650

750 E 34th St
Hibbing, MN 55746
Phone (218) 262-3441

402 E Platt Ave
Nashwauk, MN 55769
Phone (218) 885-2858

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

400 10th St E
Waconia, MN 55387

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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": "1283472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733875200000",
    "number": "1932416435",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "512 SKYLINE BLVD STE 1",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201199",
            "telephone_number": "218-879-4641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "512 SKYLINE BLVD STE 1",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "557201199",
            "telephone_number": "218-879-4641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PALOKANGAS",
        "first_name": "GLEN",
        "middle_name": "DAVID",
        "credential": "APRN, CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-09-03",
        "last_updated": "2024-12-11",
        "certification_date": "2024-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "R155380-2",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hisdept@direct.cloquethospital.com",
            "affiliation": "N",
            "address_1": "512 Skyline Blvd Ste 1",
            "city": "Cloquet",
            "state": "MN",
            "country_code": "US",
            "postal_code": "557201199",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cloquet, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2024; 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.