Active NPI
Todd Borstad, LICSW
- Clinical Social Worker
- Eagan, MN
National Provider Identifier
1033353669
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 17389
- Practice address
- 3450 O'Leary Lane
Eagan, MN 55123 - Phone
- (651) 454-0114
- Fax
- (651) 454-3492
- NPI assigned
- Apr 27, 2009
- Last updated
- Apr 27, 2009
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 17389 | MN | Primary |
Addresses
Primary practice location
3450 O'Leary Lane
Eagan, MN 55123
Mailing address
3450 Oleary LN
Eagan, MN 55123-2340
Phone (651) 454-0114
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17389 | MN | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Teladoc Health Medical Group, P.a. | Clinical | Current | Accepting new patients |
Interoperability endpoints
- toddborstad@tdh.allscriptsdirect.net
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1240790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1240790400000",
"number": "1033353669",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3450 OLEARY LN",
"city": "EAGAN",
"state": "MN",
"postal_code": "551232340",
"telephone_number": "651-454-0114",
"fax_number": "651-454-9492"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3450 O'LEARY LANE",
"city": "EAGAN",
"state": "MN",
"postal_code": "55123",
"telephone_number": "651-454-0114",
"fax_number": "651-454-3492"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BORSTAD",
"first_name": "TODD",
"name_prefix": "Mr.",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-04-27",
"last_updated": "2009-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MN",
"license": "17389",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Eagan, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.