ST. PAUL NEUROPSYCHOLOGY SERVICES, P.A. - NPI NUMBER 1467439067

Summary

Provider Name: ST. PAUL NEUROPSYCHOLOGY SERVICES, P.A.

NPI Number: 1467439067

Clasification: Psychologist (103TC0700X)

Specialization: Clinical

Address:
1789 WOODLANE DR
SUITE C
WOODBURY, MN
ZIP 55125

Phone Number: (651) 501-4957



Detailed Information

ST. PAUL NEUROPSYCHOLOGY SERVICES, P.A. is a clinical psychologist in Woodbury, MN. The assigned NPI number for this provider is 1467439067 and is registered as an organization entity type and is a multi-specialty group.

The provider's business address is:

1789 WOODLANE DR
SUITE C
WOODBURY, MN
ZIP 55125-910
Phone: (651) 501-4957

The provider's authorized official is Laura Mcdaniels .
The authorized official title is Owner and has the following contact phone number (651) 501-4957.

The enumeration date for this NPI number is 12/27/2005 and was last updated on 7/8/2007.

Map - Location of Practice

Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 103TC0700X Psychologist Clinical X
2 103G00000X Clinical Neuropsychologist X
3 103T00000X Psychologist X

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 P00092642 OTHER MN RAILROAD MEDICARE
2 141783 OTHER MN UCARE AND BHP
3 61-78127 OTHER MN MEDICA AND UBH
4 C04138 MEDICARE ID-TYPE UNSPECIFIED MN
5 103221 OTHER MN HEALTHPARTNERS
6 277S5MC OTHER MN BLUE CROSS

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1467439067 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name ST. PAUL NEUROPSYCHOLOGY SERVICES, P.A. The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 1789 WOODLANE DR The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address SUITE C The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name WOODBURY The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name MN The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 551253910 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 6515014957 The telephone number associated with the location address of the provider being identified.
12 Provider Enumeration Date 12/27/2005 The date the provider was assigned a unique identifier (assigned an NPI).
13 Last Update Date 7/8/2007 The date that a record was last updated or changed.
14 Authorized Official Last Name MCDANIELS The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
15 Authorized Official First Name LAURA The first name of the authorized official.
16 Authorized Official Title or Position OWNER The title or position of the authorized official.
17 Authorized Official Telephone Number 6515014957 The 10-position telephone number of the authorized official.
18 Healthcare Provider Taxonomy Code 1 103TC0700X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
19 Healthcare Provider Primary Taxonomy Switch 1 X
20 Healthcare Provider Taxonomy Code 2 103G00000X
21 Healthcare Provider Primary Taxonomy Switch 2 X
22 Healthcare Provider Taxonomy Code 3 103T00000X
23 Healthcare Provider Primary Taxonomy Switch 3 X
24 Other Provider Identifier 1 P00092642 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
25 Other Provider Identifier Type Code 1 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
26 Other Provider Identifier State 1 MN
27 Other Provider Identifier Issuer 1 RAILROAD MEDICARE
28 Other Provider Identifier 2 141783 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
29 Other Provider Identifier Type Code 2 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
30 Other Provider Identifier State 2 MN
31 Other Provider Identifier Issuer 2 UCARE AND BHP
32 Other Provider Identifier 3 61-78127 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
33 Other Provider Identifier Type Code 3 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
34 Other Provider Identifier State 3 MN
35 Other Provider Identifier Issuer 3 MEDICA AND UBH
36 Other Provider Identifier 4 C04138 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
37 Other Provider Identifier Type Code 4 04 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
38 Other Provider Identifier State 4 MN
39 Other Provider Identifier 5 103221 Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
40 Other Provider Identifier Type Code 5 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
41 Other Provider Identifier State 5 MN
42 Other Provider Identifier Issuer 5 HEALTHPARTNERS
43 Other Provider Identifier 6 277S5MC Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form.
44 Other Provider Identifier Type Code 6 01 Code indicating the type of identifier currently or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form.
45 Other Provider Identifier State 6 MN
46 Other Provider Identifier Issuer 6 BLUE CROSS
47 Authorized Official Credential Text PSY.D., L.P.
48 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP
49 Healthcare Provider Taxonomy Group 2 193200000X MULTI-SPECIALTY GROUP
50 Healthcare Provider Taxonomy Group 3 193200000X MULTI-SPECIALTY GROUP

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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