MODERN THERAPEUTICS PLLC — NPI 1356159891 (Board-Certified Anesthesiologist & Interventional Pain Specialist in NORTHFIELD, MN)

CMS-1500 Box 24J / 33a • NPI

1356159891

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

207L00000X (CMS 05)

Board-Certified Anesthesiologist & Interventional Pain Specialist

Box 32 Service Location & ZIP+4

502 DIVISION ST S, NORTHFIELD, MN, 55057-2020

✓ 9-Digit EDI 837 ZIP+4 (55057-2020)

Practice Phone & Referral Fax

(612) 488-2248

Fax: (612) 488-2248

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1356159891 (MODERN THERAPEUTICS PLLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1356159891` (NPI-2 Organization / Facility)
Provider / Legal Name	MODERN THERAPEUTICS PLLC
Plain-English Specialty	Board-Certified Anesthesiologist & Interventional Pain Specialist NUCC Code: `207L00000X` (Anesthesiology)
Certifying / Licensing Body	American Board of Anesthesiology (ABA)
Practice Location Address	502 DIVISION ST S, NORTHFIELD, MN, 55057-2020
Practice Telephone / Fax	Tel: (612) 488-2248 \| Fax: (612) 488-2248
Administrative Mailing Address	502 DIVISION ST S, NORTHFIELD, MN, 55057-2020
Enumeration & Last Sync	Enumerated: 2024-12-30 \| CMS Record Updated: 2026-08-17
Authorized Official	ANDREA BERUBE (Owner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

502 DIVISION ST S, NORTHFIELD, MN, 55057-2020

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Plain-English Taxonomy & CMS Crosswalk (207L00000X)

What Does Taxonomy Code 207L00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207L00000X translates to:
"Board-Certified Anesthesiologist & Interventional Pain Specialist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 05 (Physician/Anesthesiology) • CMS Code 79 (Physician/Addiction Medicine)
Certifying / Accrediting Authority: American Board of Anesthesiology (ABA)
Clinical Scope: Pre-surgical anesthesia evaluation, obstetric labor epidural care, or interventional spine and nerve block procedures for chronic pain.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (MODERN THERAPEUTICS PLLC)

Typical CPT / Diagnostic Procedures:

General Endotracheal Anesthesia & Total Intravenous Anesthesia (TIVA)
Ultrasound-Guided Peripheral Nerve Blocks & Labor Epidural Analgesia
Fluoroscopic Epidural Steroid Injections & Facet Joint Blocks

Common Therapeutic Classes:

Propofol, Sevoflurane, Rocuronium & Sugammadex
Bupivacaine, Lidocaine & Ropivacaine Regional Anesthetics

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`207L00000X` — Anesthesiology Plain English: Board-Certified Anesthesiologist & Interventional Pain Specialist	State: N/A \| License: `Verified` \| Primary: Yes (Primary)
`261QM0850X` — Clinic/Center, Adult Mental Health Plain English: Licensed Outpatient Medical Clinic / Urgent Care & Ambulatory Center	State: N/A \| License: `Verified` \| Primary: Secondary

Medical Billing, RCM & Hospital Credentialing Teams:

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MODERN THERAPEUTICS PLLC (NPI #1356159891)