PARK NICOLLET METHODIST HOSPITAL (NPI# 1083622047) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083622047 |
| Entity Type | Organization |
| Organization Name | PARK NICOLLET METHODIST HOSPITAL |
| Other Organization Name | PARK NICOLLET METHODIST HOSPITAL CRNAS |
| Practice Address |
6500 Excelsior Blvd St Louis Park MN 55426 |
| Mailing Address |
14700 28th Ave N Suite 20 Plymouth MN 55447 |
| Practice Telephone | 9529935000 |
| Practice Fax Number | 9529931980 |
| Mailing Telephone | 7635593779 |
| Mailing Fax Number | 7634503986 |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2019-09-09 |
| Authorized Official Name | MS. TRICIA L DEGE (SR VICE PRESIDENT, CFO) |
| Authorized Official Telephone | 9528835121 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207L00000X | Anesthesiology | Allopathic & Osteopathic Physicians | ||
| Y | 367500000X | Nurse Anesthetist, Certified Registered | Physician Assistants & Advanced Practice Nursing Providers |
| Other Name | Type Code |
|---|---|
| Park Nicollet Methodist Hospital CRNAs | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649827973 | Park Nicollet Methodist Hospital | Clinic/Center | 14050 Fairview Dr, Burnsville, MN 55337-5713 | 2019-08-21 |
| 1689112898 | Park Nicollet Methodist Hospital | Pharmacy | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2017-02-08 |
| 1174980692 | Park Nicollet Methodist Hospital | General Acute Care Hospital | 15800 95th Ave N, Maple Grove, MN 55369-4400 | 2016-01-28 |
| 1245615772 | Park Nicollet Methodist Hospital | General Acute Care Hospital | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2015-07-27 |
| 1194113217 | Park Nicollet Methodist Hospital | General Acute Care Hospital | 3900 Park Nicollet Blvd, St Louis Park, MN 55416-2503 | 2014-12-23 |
| 1942585286 | Park Nicollet Methodist Hospital | General Acute Care Hospital | 3525 Monterey Dr, St Louis Park, MN 55416-5275 | 2011-10-19 |
| 1578717336 | Park Nicollet Methodist Hospital | Community Based Residential Treatment Facility, Mental Illness | 3525 Monterey Dr, St Louis Park, MN 55416-5275 | 2008-11-06 |
| 1942424742 | Park Nicollet Methodist Hospital | Pharmacy | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2007-04-12 |
| 1255478798 | Park Nicollet Methodist Hospital | Durable Medical Equipment & Medical Supplies | 6500 Excelsior Blvd, St Louis Park, MN 55426 | 2007-02-01 |
| 1447201421 | Park Nicollet Methodist Hospital | Home Health | 6500 Excelsior Blvd, St Louis Park, MN 55426 | 2006-05-13 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | PARK NICOLLET METHODIST HOSPITAL | 6500 Excelsior Blvd, Saint Louis Park, MN 55426-4702 |
| Street Address |
6500 EXCELSIOR BLVD |
| City | ST LOUIS PARK |
| State | MN |
| Zip Code | 55426 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861484669 | Robert E Haselow | Radiology | 6500 Excelsior Blvd, Methodist Radiation Therapy, St Louis Park, MN 55426-4702 | 2005-08-17 |
| 1215549381 | Katelyn Boys | Physical Therapist | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2020-08-20 |
| 1386253466 | Christine Harlander | Physical Therapist | 6500 Excelsior Blvd, St Louis Park, MN 55426-4700 | 2020-07-24 |
| 1063021210 | Ian-thomas Campbell-groen | Physical Therapist | 6500 Excelsior Blvd, St Louis Park, MN 55426-4700 | 2020-07-23 |
| 1619585387 | Kelly Faber | Physical Therapist | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2020-07-20 |
| 1952938821 | Paige Rygg | Physical Therapist | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2020-03-23 |
| 1801427406 | Brandi Jo St. Mane | Nurse Anesthetist, Certified Registered | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2020-02-01 |
| 1811528680 | Brian Servey IIi | Nurse Anesthetist, Certified Registered | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2020-01-30 |
| 1245873421 | Weston Poucher | Nurse Anesthetist, Certified Registered | 6500 Excelsior Blvd, St Louis Park, MN 55426-4700 | 2019-10-21 |
| 1427609973 | Lauren Damrow | Registered Nurse | 6500 Excelsior Blvd, St Louis Park, MN 55426-4700 | 2019-09-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821657545 | Big Brain Concussion Recovery & Chiropractic Pa | Chiropractor | 3313 Republic Ave., St. Louis Park, MN 55426 | 2019-06-06 |
| 1912485095 | Daniel Raies | Optometrist | 8900 Minnesota 7, St Louis Park, MN 55426 | 2018-08-01 |
| 1649756040 | Wayside House, Inc. | Clinic/Center | 1349 Jersey Ave S, St. Louis Park, MN 55426 | 2018-07-18 |
| 1104302884 | Superior Caregivers, LLC | In Home Supportive Care | 1319 Lancaster Ave., St. Louis Park, MN 55426 | 2018-07-16 |
| 1396234266 | Caitlin Kwiatkowski | Behavior Technician | 7010 Mn-7, St.louis Park, MN 55426 | 2018-05-07 |
| 1497244313 | Kelly Ann Clancey | Behavior Technician | 7010 Highway 2, Saint Louis Park, MN 55426 | 2018-05-07 |
| 1770072696 | Ashleigh Hakala | Behavior Technician | 7010 Highway 7 St. Louis Park Mn 55426, St. Louis Park, MN 55426 | 2018-05-07 |
| 1689181521 | Glenda Miles | Registered Nurse | 7316 Cedar Lake Road, Apt 8, St Louis Park, MN 55426 | 2017-12-31 |
| 1174041875 | Kristen Webb | Physician Assistant | 3931 Louisiana Ave S, Suite E-500, St. Louis Park, MN 55426 | 2017-09-01 |
| 1447775549 | Belinda Sue Bliss | Marriage & Family Therapist | 3301 Decatur Lane, Saint Louis Park, MN 55426 | 2017-08-09 |
| Find all providers in zip 55426 | ||||
| Taxonomy Code | 367500000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Anesthetist, Certified Registered |
| (1) A licensed registered nurse with advanced specialty education in anesthesia who, in collaboration with appropriate health care professionals, provides preoperative, intraoperative, and postoperative care to patients and assists in management and resuscitation of critical patients in intensive care, coronary care, and emergency situations. Nurse anesthetists are certified following successful completion of credentials and state licensure review and a national examination directed by the Council on Certification of Nurse Anesthetists. (2) A registered nurse who is qualified by special training to administer anesthesia in collaboration with a physician or dentist and who can assist in the care of patients who are in critical condition. |
| Notes: Sources: (1) Council on Certification of Nurse Anesthetists, Park Ridge, IL, and Rhea, Ott, and Shafritz, The Facts On File Dictionary of Health Care Management, New York: Facts On File Publications, 1988. (2) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 548. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073858718 | Universal Anesthesia Inc | Nurse Anesthetist, Certified Registered | 6980 Oxford St Ste 170, St Louis Park, MN 55426-4523 | 2012-12-06 |
| 1801427406 | Brandi Jo St. Mane | Nurse Anesthetist, Certified Registered | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2020-02-01 |
| 1811528680 | Brian Servey IIi | Nurse Anesthetist, Certified Registered | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2020-01-30 |
| 1245873421 | Weston Poucher | Nurse Anesthetist, Certified Registered | 6500 Excelsior Blvd, St Louis Park, MN 55426-4700 | 2019-10-21 |
| 1851868673 | Scott Michael Krohn | Nurse Anesthetist, Certified Registered | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2018-10-30 |
| 1619452075 | Samuel Patrick Faunillan Otis | Nurse Anesthetist, Certified Registered | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2018-10-01 |
| 1982111647 | Tyler Forrest Pangerl | Nurse Anesthetist, Certified Registered | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2018-01-03 |
| 1780103655 | Sarah Loots | Nurse Anesthetist, Certified Registered | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2017-09-12 |
| 1063956936 | Adrienne Backus | Nurse Anesthetist, Certified Registered | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2016-12-13 |
| 1568910396 | Lindsey Demesy | Nurse Anesthetist, Certified Registered | 6500 Excelsior Blvd, St Louis Park, MN 55426-4702 | 2016-09-21 |
| Find all providers in ST LOUIS PARK | ||||
| City | ST LOUIS PARK |
| Zip Code | 55426 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.