Individual provider Active NPI

Sasha Marie Tisdell

  • Registered Nurse
  • Minneapolis, MN
National Provider Identifier
1932539079
Registry record updated Jan 11, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
R175275-5 Issued in MN
Practice address
2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone
(612) 365-1000
NPI assigned
Nov 26, 2013
Last updated
Jan 11, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 11, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 100390 MN
Registered Nurse 163W00000X R175275-5 MN Primary

Addresses

Primary practice location

2450 Riverside Ave
Minneapolis, MN 55454-1450

Mailing address

2450 Riverside Ave
Minneapolis, MN 55454-1450
Phone (612) 365-1000

Other names 1

  • Miss Sasha Marie Miller Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140114001102 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 4082842224 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mngi Digestive Health PAGroup PAC ID 8123016557, 276 clinicians

Practice addresses (Care Compare)

3001 Broadway St NE
Suite 500
Minneapolis, MN 55413-2197
Phone (612) 871-1145

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R175275-5MNMDRegistered Nurse
100390MNMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Mngi Digestive Health, P.a. CurrentSince Sep 29, 2020 Accepting new patients
University Anesthesia Providers, LLC Nurse Anesthetist, Certified Registered CurrentSince Jan 1, 2016 Accepting new patients

Locations

9145 Springbrook Dr NW
Ste 200
Coon Rapids, MN 55433
Phone (612) 625-8999

1185 Town Centre Dr
Ste 205
Eagan, MN 55123

2450 Riverside Ave
Minneapolis, MN 55454
Phone (612) 273-7838

3001 Broadway St NE
Ste 500
Minneapolis, MN 55413
Phone (612) 870-5557

500 Harvard St SE
Minneapolis, MN 55455
Phone (612) 273-7300

15700 37th Ave N
Plymouth, MN 55446
Phone (763) 577-0008

237 Radio Dr
Ste 200
Woodbury, MN 55125

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1385424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1389398400000",
    "number": "1932539079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-365-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 RIVERSIDE AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554541450",
            "telephone_number": "612-365-1000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TISDELL",
        "first_name": "SASHA",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-26",
        "last_updated": "2014-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "100390",
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MN",
            "license": "R175275-5",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SASHA",
            "last_name": "MILLER",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2014; 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.