Individual provider Active NPI

John Gatermann, PSYD

  • Psychologist
  • Minneapolis, MN
National Provider Identifier
1043792666
Registry record updated Aug 30, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP6278 Issued in MN
Practice address
1313 Penn Ave N
Minneapolis, MN 55411-3047
Phone
(612) 543-3794
Fax
(612) 302-4872
NPI assigned
Aug 30, 2018
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X LP6278 MN Primary

Addresses

Primary practice location

1313 Penn Ave N
Minneapolis, MN 55411-3047

Mailing address

1313 Penn Ave N
Minneapolis, MN 55411-3047
Phone (612) 543-3794

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190206000093 MN Practitioner - Clinical Psychologist 6901144682 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hennepin CountyGroup PAC ID 7911892849, 132 clinicians

Practice addresses (Care Compare)

1313 Penn N Ave
Minneapolis, MN 55411-3047
Phone (612) 543-2500

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
LP6278MNMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hennepin County CurrentSince Dec 15, 2018 Accepting new patients
Hennepin County Psychologist Current Accepting new patients
Hennepin County CurrentSince Dec 15, 2018 Accepting new patients

Locations

1313 Penn Ave N
Minneapolis, MN 55411
Phone (612) 302-4600

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535587200000",
    "number": "1043792666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1313 PENN AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554113047",
            "telephone_number": "612-543-3794",
            "fax_number": "612-302-4872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 PENN AVE N",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554113047",
            "telephone_number": "612-543-3794",
            "fax_number": "612-302-4872"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GATERMANN",
        "first_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "PSYD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-08-30",
        "last_updated": "2018-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP6278",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.