Ethan Petersen, CRNA - Medicare Nurse Anesthetist, Certified Registered in Saint Cloud, MN

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Ethan Petersen, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in Saint Cloud, Minnesota. His current practice location is 1406 6th Ave N, Saint Cloud, Minnesota. You can reach out to his office (for appointments etc.) via phone at (320) 251-2700.

Ethan Petersen is licensed to practice in Minnesota (license number R 193342-2) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1851615108.

Contact Information

Ethan Petersen, CRNA
1406 6th Ave N,
Saint Cloud, MN 56303-1900
(320) 251-2700
Not Available

Map and Direction




Provider's Profile

Full NameEthan Petersen
GenderMale
SpecialityNurse Anesthetist, Certified Registered
Location1406 6th Ave N, Saint Cloud, Minnesota
Accepts Medicare AssignmentsMedicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1851615108
  • Provider Enumeration Date: 03/16/2010
  • Last Update Date: 03/16/2010
  Medicare PECOS Information:
  • PECOS PAC ID: 0446382162
  • Enrollment ID: I20100715000875

Medical Identifiers

Medical identifiers for Ethan Petersen such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1851615108NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
367500000XNurse Anesthetist, Certified Registered R 193342-2 (Minnesota)Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Ethan Petersen allows following entities to bill medicare on his behalf.
Entity NameCentracare Clinic
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1043212665
PECOS PAC ID: 2466363395
Enrollment ID: O20031105000293
Entity NameAnesthesiology, P.a.
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1013960798
PECOS PAC ID: 9335033034
Enrollment ID: O20040212000459
Entity NameAllina Health System
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1295272342
PECOS PAC ID: 4587573613
Enrollment ID: O20040319000460
Entity NameSt Cloud Outpatient Surgery Ltd
Entity TypePart B Supplier - Ambulatory Surgical Center
Entity IdentifiersNPI Number: 1124084843
PECOS PAC ID: 6800877622
Enrollment ID: O20040527000651
Entity NameCertified Anesthesia Care Co
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1699736348
PECOS PAC ID: 9436439114
Enrollment ID: O20161215001488

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Ethan Petersen is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Ethan Petersen, CRNA
3701 12th St N, Suite 202,
Saint Cloud, MN 56303-2255

Ph: (320) 258-3090		Ethan Petersen, CRNA
1406 6th Ave N,
Saint Cloud, MN 56303-1900

Ph: (320) 251-2700

Reviews and Comments


Nurse Anesthetist, Certified Registered Nurses in Saint Cloud, MN

Craig Tangen,
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 3701 12th St N, Suite 202, Saint Cloud, MN 56303
Phone: 320-258-3090    
Kimberly Huschle,
Nurse Anesthetist - CR
Medicare: Medicare Enrolled
Practice Location: 3701 12th St N, Suite 202, Saint Cloud, MN 56303
Phone: 320-258-3090    
Kayla Jane Elwood,
Nurse Anesthetist - CR
Medicare: Medicare Enrolled
Practice Location: 3701 12th St N, Suite 202, Saint Cloud, MN 56303
Phone: 320-258-3090    
Stephany S Latunski, CRNA
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 1406 6th Ave N, Saint Cloud, MN 56303
Phone: 320-251-2700    
Penny Renee Janorschke, CRNA
Nurse Anesthetist - CR
Medicare: Not Enrolled in Medicare
Practice Location: 1406 6th St N, Saint Cloud, MN 56303
Phone: 320-251-2700    Fax: 320-656-7092
Nicholas M Lejcher, CRNA
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 1406 6th Ave N, Saint Cloud, MN 56303
Phone: 320-251-2700    
Bertil Lindquist,
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 3701 12th St N Ste 202, Saint Cloud, MN 56303
Phone: 320-258-3090    Fax: 320-258-3095

Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.