Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Samuel Patrick Faunillan Otis, CRNA

Individual provider Certified Registered Nurse Anesthetist · NPI 1619452075

Samuel Patrick Faunillan Otis, CRNA is a Certified Registered Nurse Anesthetist (CRNA) in St Louis Park, Minnesota. Qualified in 2018, 8 years ago. Practices with Park Nicollet Methodist Hospital, a 112-clinician group, works from 2 locations and accepts Medicare assignment. Licensed in Minnesota.

Years since qualifying
8
Licensed in
MN
In the registry since
2018
What do these letters mean?
CRNA — Certified Registered Nurse Anesthetist
An advanced practice nurse who administers anaesthesia.

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Practice location Address checks out

6500 Excelsior Blvd
St Louis Park, MN 55426-4702
Phone: (952) 993-5000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 2104 Northdale Blvd Nw Ste 220, Coon Rapids, MN 55433-3046 — (763) 537-6000

Specialties & licences

Certified Registered Nurse Anesthetist (primary) Taxonomy 367500000X · Licence 2287 (MN)

Record details

NPI number1619452075
Entity typeIndividual (Type 1)
GenderMale
Credentials CRNA
Sole proprietorNo
NPI enumeratedOctober 1, 2018
Last updated in NPPESNovember 24, 2025
Certification dateNovember 24, 2025

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Park Nicollet Methodist Hospital — 112 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

Other providers in St Louis Park