CASSANDRA TIEDTKE (CRNA) – Certified Registered Nurse Anesthetist, NPI 1194195156

CASSANDRA TIEDTKE (CRNA) is a healthcare provider. based in Minneapolis, Minnesota. specializing in CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA). They hold the professional credentials CRNA. They hold a License No. R 199671-5 (MN). The NPI Number for CASSANDRA TIEDTKE (CRNA) is 1194195156

Main info

Female
11 Years Of Experience
Accepts Medicare Assignment
Name
CASSANDRA TIEDTKE (CRNA)
NPI
1194195156
Phone
(612) 672-6000
Address
2450 RIVERSIDE AVE
Enumeration Date
3 October 2015
Last Update Date
3 October 2018

Doctor Profile

Medical School Name
OTHER
Secondary Phone
9529937800
Graduation Year
2015 (11 years ago)
PAC ID
5092018200
Group Practice PAC ID
2466986922
Professional Enrollment ID
I20160121002463
Address ID
MN553795582SH1700XAVEX401
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience43
Completeness75
Years active:10State licenses:2Digital endpointsOther names

2,131 CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA) in MN

Provider Addresses for CASSANDRA TIEDTKE (CRNA)

  • 2450 RIVERSIDE AVE

    MINNEAPOLIS, MN 554541450

    Phone: (612) 672-6000

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2016-01-21

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20160121002463ICertified Registered Nurse Anesthetist (Crna)MNTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 55454)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2466986922View full group profile
NameSpecialtyState
Certified Registered Nurse Anesthetist (Crna)MN
Certified Registered Nurse Anesthetist (Crna)WI
Certified Registered Nurse Anesthetist (Crna)MN
Certified Registered Nurse Anesthetist (Crna)OR
Certified Registered Nurse Anesthetist (Crna)MN
Certified Registered Nurse Anesthetist (Crna)MN
Certified Registered Nurse Anesthetist (Crna)MN
Certified Registered Nurse Anesthetist (Crna)MN
Certified Registered Nurse Anesthetist (Crna)MN
Certified Registered Nurse Anesthetist (Crna)MN

Reviews

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Frequently asked questions

Can I use this page to confirm CASSANDRA TIEDTKE (CRNA)'s NPI?
Yes. CASSANDRA TIEDTKE (CRNA) is listed with NPI 1194195156 in the public NPI dataset.
Is CASSANDRA TIEDTKE (CRNA) still practicing?
CASSANDRA TIEDTKE (CRNA) is currently listed as active in the public NPI registry.
What is CASSANDRA TIEDTKE (CRNA)'s specialty?
The listing groups CASSANDRA TIEDTKE (CRNA) with Certified Registered Nurse Anesthetist. Clinical services aligned with this taxonomy classification.
What address line appears for CASSANDRA TIEDTKE (CRNA)?
CASSANDRA TIEDTKE (CRNA)'s geographic hint is Minneapolis, Minnesota in our summary view.
How many locations tie to this NPI?
2 practice locations appear in the available data.

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