James Tutu Fiske I, DNP/PMHNP
Individual provider Active NPI Psychiatric/Mental Health Nurse Practitioner · Bloomington, MN
NPI 1013525534 · NPPES record last updated Dec 22, 2023
Key facts
- NPI
- 1013525534
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychiatric/Mental Health Nurse Practitioner 363LP0808X
- License
- 11098 (MN)
- Practice address
- 3601 Minnesota Dr Ste 170
Bloomington, MN 55435-5202 - Phone
- (844) 994-3631
- NPI assigned
- Jul 21, 2020
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2019
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
- Natalis Counseling and Psychology Solutions, P.a.
Family Innovations Inc
Practice addresses (Care Compare)
1600 University Ave W
Saint Paul, MN 55104-3898
Phone (651) 379-5157
3601 Minnesota Dr
Suite 170
Bloomington, MN 55435-5202
Phone (753) 421-5535
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240507001261 | MN | Practitioner - Nurse Practitioner | 5294131520 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11098 | MN | MD | Psychiatric/Mental Health Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Favorgrace Wellness Clinic | Psychiatric/Mental Health | Current |
Accepting new patients |
| Natalis Counseling and Psychology Solutions, P.a. | Current |
Accepting new patients | |
| Family Innovations, Inc. | Psychiatric/Mental Health | Current |
Accepting new patients |
| West Central Counseling LLC | Past |
Accepting new patients | |
| Crossroads Integrated Care Osborn | Past |
Accepting new patients | |
| Health Group Providers, LLC | Past |
Accepting new patients |
Locations
121 5th Ave W
Alexandria, MN 56308
Phone (320) 759-3096
1833 3rd Ave
Anoka, MN 55303
Phone (763) 421-5535
6160 Summit Dr N
Ste 231
Brooklyn Center, MN 55430
Phone (612) 364-2297
3601 Minnesota Dr
Ste 170
Minneapolis, MN 55435
Phone (612) 924-1421
1600 University Ave W
Saint Paul, MN 55104
Phone (651) 644-1813
7582 Currell Blvd
Ste 114
Woodbury, MN 55125
Phone (651) 379-5159
Interoperability endpoints
- lifestancehealth.jamesfiske@149810.advancedmd-direct.com
- james.fiske.1@24259.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatric/Mental Health Nurse Practitioner | 363LP0808X | 11098 | MN | Yes |
Addresses
Primary practice location
3601 Minnesota Dr Ste 170
Bloomington, MN 55435-5202
Mailing address
3601 Minnesota Dr Ste 170
Bloomington, MN 55435-5202
Phone (612) 927-2040
Other providers in Bloomington, MN
- Zachary Steven Finn
- David A Fischer
- Keith Fischer
- Melissa Page Fischer
- Michael Fischer
- Michael Fitzgerald
- Michelle Fitzpatrick
- Five Pillars Community Supports LLC
- Jane E Flad
- Grace Honderich Flannery
All providers in Bloomington, MN · Psychiatric/Mental Health Nurse Practitioner in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 22, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.