Samuel Patrick Faunillan Otis, CRNA - Medicare Certified Registered Nurse Anesthetist (crna) in St Louis Park, MN

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Samuel Patrick Faunillan Otis, CRNA is a medicare enrolled "Nurse Anesthetist, Certified Registered" in St Louis Park, Minnesota. He graduated from nursing school in 2018 and has 6 years of diverse experience with area of expertise as Certified Registered Nurse Anesthetist (crna). He is a member of the group practice Nura Pllc, Allina Health System, Metropolitan Anesthesia Network Llp, Park Nicollet Methodist Hospital and his current practice location is 6500 Excelsior Blvd, St Louis Park, Minnesota. You can reach out to his office (for appointments etc.) via phone at (952) 993-5000.

Samuel Patrick Faunillan Otis is licensed to practice in Minnesota (license number 2287) and he also participates in the medicare program. He accepts medicare assignments (which means he accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and his NPI Number is 1619452075.

Contact Information

Samuel Patrick Faunillan Otis, CRNA
6500 Excelsior Blvd,
St Louis Park, MN 55426-4702
(952) 993-5000
Not Available

Map and Direction




Provider's Profile

Full NameSamuel Patrick Faunillan Otis
GenderMale
SpecialityCertified Registered Nurse Anesthetist (crna)
Experience6 Years
Location6500 Excelsior Blvd, St Louis Park, Minnesota
Accepts Medicare AssignmentsYes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance.
  Medical Education and Training:
  • Samuel Patrick Faunillan Otis graduated from nursing school in 2018
  NPI Data:
  • NPI Number: 1619452075
  • Provider Enumeration Date: 10/01/2018
  • Last Update Date: 06/03/2022
  Medicare PECOS Information:
  • PECOS PAC ID: 8325385651
  • Enrollment ID: I20190124002554

Medical Identifiers

Medical identifiers for Samuel Patrick Faunillan Otis such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1619452075NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
367500000XNurse Anesthetist, Certified Registered 2287 (Minnesota)Primary

Medical Facilities Affiliation

Facility NameLocationFacility Type
Ridgeview Medical CenterWaconia, MNHospital
Park Nicollet Methodist HospitalSaint louis park, MNHospital
Abbott Northwestern HospitalMinneapolis, MNHospital

Group Practice Association

Group Practice NameGroup PECOS PAC IDNo. of Members
Nura Pllc276937894224
Allina Health System45875736133071
Metropolitan Anesthesia Network Llp5698689123647
Park Nicollet Methodist Hospital731584006398

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. Samuel Patrick Faunillan Otis allows following entities to bill medicare on his behalf.
Entity NamePark Nicollet Clinic
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1780621904
PECOS PAC ID: 7911819438
Enrollment ID: O20031104000046
Entity NameHealtheast Woodwinds Hospital
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1356309322
PECOS PAC ID: 9638082563
Enrollment ID: O20031107000110
Entity NameMetropolitan Anesthesia Network Llp
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1558314427
PECOS PAC ID: 5698689123
Enrollment ID: O20031118000579
Entity NameHealtheast Medical Research Institute
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1639125503
PECOS PAC ID: 3971407636
Enrollment ID: O20031124000507
Entity NameHealtheast St Joseph's Hospital
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1134186273
PECOS PAC ID: 2365348869
Enrollment ID: O20031208000245
Entity NameHealtheast St John's Hospital
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1447218482
PECOS PAC ID: 9234035742
Enrollment ID: O20031208000320
Entity NameHealtheast Care System
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1194787465
PECOS PAC ID: 7214833763
Enrollment ID: O20031208000483
Entity NamePark Nicollet Methodist Hospital
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1083622047
PECOS PAC ID: 7315840063
Enrollment ID: O20040129000853
Entity NameAllina Health System
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1295272342
PECOS PAC ID: 4587573613
Enrollment ID: O20040319000460
Entity NameNura Pllc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1750316014
PECOS PAC ID: 2769378942
Enrollment ID: O20040322000281
Entity NameUniversity Anesthesia Providers Llc
Entity TypePart B Supplier - Clinic/group Practice
Entity IdentifiersNPI Number: 1699711143
PECOS PAC ID: 7315986064
Enrollment ID: O20050502000881

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. Samuel Patrick Faunillan Otis 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
Samuel Patrick Faunillan Otis, CRNA
8170 33rd Ave S # Ms 21110q,
Bloomington, MN 55425-4516

Ph: () -		Samuel Patrick Faunillan Otis, CRNA
6500 Excelsior Blvd,
St Louis Park, MN 55426-4702

Ph: (952) 993-5000

Reviews and Comments


Nurse Anesthetist, Certified Registered Nurses in St Louis Park, MN

Lindsey Marie Knapp, CRNA
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 6500 Excelsior Blvd, St Louis Park, MN 55426
Phone: 952-993-5000    
Ms. Susan J Bermel, CRNA
Nurse Anesthetist - CR
Medicare: Not Enrolled in Medicare
Practice Location: 6500 Excelsior Blvd, Anesthesiology, St Louis Park, MN 55426
Phone: 952-993-5222    
Adrienne Backus,
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 6500 Excelsior Blvd, St Louis Park, MN 55426
Phone: 952-993-5000    
Frank A Jirik,
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 6500 Excelsior Blvd, St Louis Park, MN 55426
Phone: 952-993-5000    
Carie Voges,
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 6500 Excelsior Blvd, St Louis Park, MN 55426
Phone: 952-993-5000    
Joseph Stephen Henefield,
Nurse Anesthetist - CR
Medicare: Accepting Medicare Assignments
Practice Location: 6500 Excelsior Blvd, St Louis Park, MN 55426
Phone: 952-993-5222    Fax: 952-993-6499
Janet Moore,
Nurse Anesthetist - CR
Medicare: Not Enrolled in Medicare
Practice Location: 6500 Excelsior Blvd, St Louis Park, MN 55426
Phone: 952-993-5222    

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.