Individual provider Active NPI

Brandon S Percival, APRN,CRNA

  • Certified Registered Nurse Anesthetist
  • Duluth, MN
National Provider Identifier
1962050906
Registry record updated Sep 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
2357 Issued in MN
Practice address
400 E Third Street
Duluth, MN 55805-1951
Phone
(218) 786-8364
NPI assigned
Sep 3, 2019
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 17, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Certified Registered Nurse Anesthetist 367500000X 2357 MN Primary

Addresses

Primary practice location

400 E Third Street
Duluth, MN 55805-1951

Mailing address

400 E 3Rd St
Duluth, MN 55805-1951

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20190926001190 MN Practitioner - Certified Registered Nurse Anesthetist (Crna) 7810227329 Reassigns benefits to 6 organizations
I20200625002484 WI Practitioner - Certified Registered Nurse Anesthetist (Crna) 7810227329 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, shared by 25 NPIs, 1,135 clinicians
Community Memorial Hospital AssociationGroup PAC ID 0042129991, 47 clinicians

Practice addresses (Care Compare)

1542 Golf Course Rd
Suite 204
Grand Rapids, MN 55744-3537
Phone (218) 999-7000

3500 Tower Ave
Superior, WI 54880-5335
Phone (715) 395-5454

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

Hospital & facility affiliations

  • Community Memorial Hospital Hospital, Cloquet, MN, CCN 241364
  • Essentia Health St Mary'S Medical Center Hospital, Duluth, MN, CCN 240002

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2357MNMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
The Duluth Clinic LTD CurrentSince May 19, 2025 Accepting new patients
Essentia Health Moose Lake CurrentSince May 19, 2025 Accepting new patients
Moose Lake Community Hospital District Current Accepting new patients
The Duluth Clinic, LTD Nurse Anesthetist, Certified Registered CurrentSince Jun 22, 2020 Accepting new patients
Essentia Health Moose Lake CurrentSince May 19, 2025 Accepting new patients
North Shore Anesthesia P.a Nurse Anesthetist, Certified Registered CurrentSince Apr 15, 2025 Accepting new patients
The Duluth Clinic, LTD Nurse Anesthetist, Certified Registered Current Accepting new patients
The Duluth Clinic, LTD. CurrentSince Jun 22, 2020 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients

Locations

512 Skyline Blvd
Cloquet, MN 55720
Phone (218) 878-7207

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

400 E 3rd St
Duluth, MN 55805
Phone (218) 722-8364

1542 Golf Course Rd
Ste 204
Grand Rapids, MN 55744
Phone (218) 322-4900

4572 County Road 61
Moose Lake, MN 55767
Phone (218) 485-4481

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

1101 9th St N
Virginia, MN 55792
Phone (218) 305-0000

3500 Tower Ave
Ste 1
Superior, WI 54880
Phone (715) 395-5457

3500 Tower Ave
Superior, WI 54880
Phone (715) 392-8281

Organizations & group practices 10

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 3

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": "1567468800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1568678400000",
    "number": "1962050906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E 3RD ST",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E THIRD STREET",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558051951",
            "telephone_number": "218-786-8364"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERCIVAL",
        "first_name": "BRANDON",
        "middle_name": "S",
        "credential": "APRN,CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-03",
        "last_updated": "2019-09-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MN",
            "license": "2357",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2019; 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.